Skip to main content
Top

04-05-2024 | Ischemic Stroke | Review Free for a limited time

Delving Into the Significance of Brain’s Collateral Circulation in the Era of Revascularization Therapy

Authors: Marilena Mangiardi, MD, Sergio Soeren Rossi, MD, Adriano Bonura, MD, Gianmarco Iaccarino, MD, Michele Alessiani, MD, Sabrina Anticoli, MD, Gianluca De Rubeis, MD, Enrico Pampana, MD, Francesca Romana Pezzella, MD

Published in: Current Treatment Options in Neurology

Login to get access

Abstract

Purpose of review

This narrative review summarized the major studies focusing on the association between revascularization therapies (intravenous thrombolysis and endovascular thrombectomy) and collateral circulation status in terms of outcome and safety. Our aim is to elucidate, drawing upon the latest scientific evidence, the pivotal role that collateral circulation plays in shaping the prognosis and potential therapeutic in patients with ischemic stroke.

Recent findings

The data currently available suggest that pre-treatment assessment of collateral circulation may be crucial, as a good collateral circulation status appears to be associated with better outcomes in terms of both early revascularization and long-term disability. There is limited literature about the assessment of collateral circulation prior to acute reperfusion therapy.

Summary

The role of the intracranial collateral circulation is gaining increasing attention in the field of ischemic stroke, both in terms of outcome prognosis and therapeutic interventions. These findings need to be confirmed by more structured randomized controlled trials (RCTs), but they suggest that investigating therapeutic strategies to maintain and support collateral circulation may represent the future of ischemic stroke therapy.
Literature
1.
go back to reference Saini V, Guada L, Yavagal DR. Global epidemiology of stroke and access to acute ischemic stroke interventions. Neurol. 2021;97:S6–16. Saini V, Guada L, Yavagal DR. Global epidemiology of stroke and access to acute ischemic stroke interventions. Neurol. 2021;97:S6–16.
2.
go back to reference Mosconi MG, Paciaroni M. Treatments in ischemic stroke: current and future. Eur Neurol. 2022;85:349–66.PubMedCrossRef Mosconi MG, Paciaroni M. Treatments in ischemic stroke: current and future. Eur Neurol. 2022;85:349–66.PubMedCrossRef
4.
5.
go back to reference Goyal M, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet Lond Engl. 2016;387:1723–31.CrossRef Goyal M, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet Lond Engl. 2016;387:1723–31.CrossRef
7.
go back to reference Nogueira RG, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378:11–21.PubMedCrossRef Nogueira RG, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378:11–21.PubMedCrossRef
8.
go back to reference Uniken Venema SM, Dankbaar JW, van der Lugt A, Dippel DWJ, van der Worp HB. Cerebral collateral circulation in the era of reperfusion therapies for acute ischemic stroke. Stroke. 2022;53:3222–34.PubMedCrossRef Uniken Venema SM, Dankbaar JW, van der Lugt A, Dippel DWJ, van der Worp HB. Cerebral collateral circulation in the era of reperfusion therapies for acute ischemic stroke. Stroke. 2022;53:3222–34.PubMedCrossRef
9.
go back to reference Baron J-C. The core/penumbra model: implications for acute stroke treatment and patient selection in 2021. Eur J Neurol. 2021;28:2794–803.PubMedCrossRef Baron J-C. The core/penumbra model: implications for acute stroke treatment and patient selection in 2021. Eur J Neurol. 2021;28:2794–803.PubMedCrossRef
10.
go back to reference Mangiardi M, et al. The pathophysiology of collateral circulation in acute ischemic stroke. Diagn Basel Switz. 2023;13:2425. Mangiardi M, et al. The pathophysiology of collateral circulation in acute ischemic stroke. Diagn Basel Switz. 2023;13:2425.
11.
12.
go back to reference Silvestre J-S, Smadja DM, Lévy BI. Postischemic revascularization: from cellular and molecular mechanisms to clinical applications. Physiol Rev. 2013;93:1743–802.PubMedCrossRef Silvestre J-S, Smadja DM, Lévy BI. Postischemic revascularization: from cellular and molecular mechanisms to clinical applications. Physiol Rev. 2013;93:1743–802.PubMedCrossRef
13.
go back to reference Sheth SA, Liebeskind DS. Imaging evaluation of collaterals in the brain: physiology and clinical translation. Curr Radiol Rep. 2014;2:29.PubMedCrossRef Sheth SA, Liebeskind DS. Imaging evaluation of collaterals in the brain: physiology and clinical translation. Curr Radiol Rep. 2014;2:29.PubMedCrossRef
15.
go back to reference Ginsberg MD. The cerebral collateral circulation: relevance to pathophysiology and treatment of stroke. Neuropharmacology. 2018;134:280–92.PubMedCrossRef Ginsberg MD. The cerebral collateral circulation: relevance to pathophysiology and treatment of stroke. Neuropharmacology. 2018;134:280–92.PubMedCrossRef
17.
go back to reference Tetteh G, et al. A deep learning approach to predict collateral flow in stroke patients using radiomic features from perfusion images. Front Neurol. 2023;14:1039693.PubMedPubMedCentralCrossRef Tetteh G, et al. A deep learning approach to predict collateral flow in stroke patients using radiomic features from perfusion images. Front Neurol. 2023;14:1039693.PubMedPubMedCentralCrossRef
18.
go back to reference Wardlaw JM, et al. Accuracy of automated computer-aided diagnosis for stroke imaging: a critical evaluation of current evidence. Stroke. 2022;53:2393–403.PubMedCrossRef Wardlaw JM, et al. Accuracy of automated computer-aided diagnosis for stroke imaging: a critical evaluation of current evidence. Stroke. 2022;53:2393–403.PubMedCrossRef
19.
go back to reference Seners P, et al. Incidence and predictors of early recanalization after intravenous thrombolysis: a systematic review and meta-analysis. Stroke. 2016;47:2409–12.PubMedCrossRef Seners P, et al. Incidence and predictors of early recanalization after intravenous thrombolysis: a systematic review and meta-analysis. Stroke. 2016;47:2409–12.PubMedCrossRef
20.
go back to reference Christoforidis GA, et al. Predictors of hemorrhage following intra-arterial thrombolysis for acute ischemic stroke: the role of pial collateral formation. Am J Neuroradiol. 2009;30:165–70.PubMedPubMedCentralCrossRef Christoforidis GA, et al. Predictors of hemorrhage following intra-arterial thrombolysis for acute ischemic stroke: the role of pial collateral formation. Am J Neuroradiol. 2009;30:165–70.PubMedPubMedCentralCrossRef
21.
go back to reference Bang OY, et al. Collateral flow averts hemorrhagic transformation after endovascular therapy for acute ischemic stroke. Stroke. 2011;42:2235–9.PubMedCrossRef Bang OY, et al. Collateral flow averts hemorrhagic transformation after endovascular therapy for acute ischemic stroke. Stroke. 2011;42:2235–9.PubMedCrossRef
22.
go back to reference Angermaier A, et al. CT-angiographic collateralization predicts final infarct volume after intra-arterial thrombolysis for acute anterior circulation ischemic stroke. Cerebrovasc Dis Basel Switz. 2011;31:177–84.CrossRef Angermaier A, et al. CT-angiographic collateralization predicts final infarct volume after intra-arterial thrombolysis for acute anterior circulation ischemic stroke. Cerebrovasc Dis Basel Switz. 2011;31:177–84.CrossRef
23.
go back to reference Nicoli F, de Micheaux PL, Girard N. Perfusion-weighted imaging-derived collateral flow index is a predictor of MCA M1 recanalization after i.v. thrombolysis. AJNR Am J Neuroradiol. 2013;34:107–14.PubMedPubMedCentralCrossRef Nicoli F, de Micheaux PL, Girard N. Perfusion-weighted imaging-derived collateral flow index is a predictor of MCA M1 recanalization after i.v. thrombolysis. AJNR Am J Neuroradiol. 2013;34:107–14.PubMedPubMedCentralCrossRef
24.
go back to reference Calleja AI, et al. Collateral circulation on perfusion-computed tomography-source images predicts the response to stroke intravenous thrombolysis. Eur J Neurol. 2013;20:795–802.PubMedCrossRef Calleja AI, et al. Collateral circulation on perfusion-computed tomography-source images predicts the response to stroke intravenous thrombolysis. Eur J Neurol. 2013;20:795–802.PubMedCrossRef
25.
go back to reference • Zhang S, et al. The velocity of collateral filling predicts recanalization in acute ischemic stroke after intravenous thrombolysis. Sci Rep. 2016;6:27880. This retrospective analysis evaluate the impact of pretreatment quality of collaterals, involving velocity and extent of collateral filling, on recanalization after intravenous thrombolysis . The study was performed of 66 patients with acute middle cerebral artery (MCA) M1 segment occlusion who underwent MR perfusion (MRP) imaging before IVT. The extent of collateral filling was assessed according to the Alberta Stroke Program Early CT (ASPECT) score on temporally fused maximum intensity projections (tMIP). The authors showed that when recanalization was achieved, hemorrhagic transformation occurred more frequently in patients with slow collaterals than those with rapid collaterals.PubMedPubMedCentralCrossRef • Zhang S, et al. The velocity of collateral filling predicts recanalization in acute ischemic stroke after intravenous thrombolysis. Sci Rep. 2016;6:27880. This retrospective analysis evaluate the impact of pretreatment quality of collaterals, involving velocity and extent of collateral filling, on recanalization after intravenous thrombolysis . The study was performed of 66 patients with acute middle cerebral artery (MCA) M1 segment occlusion who underwent MR perfusion (MRP) imaging before IVT. The extent of collateral filling was assessed according to the Alberta Stroke Program Early CT (ASPECT) score on temporally fused maximum intensity projections (tMIP). The authors showed that when recanalization was achieved, hemorrhagic transformation occurred more frequently in patients with slow collaterals than those with rapid collaterals.PubMedPubMedCentralCrossRef
26.
go back to reference •• Wufuer A, et al. Impact of collateral circulation status on favorable outcomes in thrombolysis treatment: a systematic review and meta-analysis. Exp Ther Med. 2018;15:707–18. This meta-analysis included a total of 29 studies involving 4053 patients. The study concludes that assessing collateral circulation and penumbra area before thrombolytic therapy can help identify AIS patients who may benefit from treatment. Good collateral circulation is associated with improved outcomes, including functional recovery, reduced hemorrhagic complications, and lower mortality.PubMed •• Wufuer A, et al. Impact of collateral circulation status on favorable outcomes in thrombolysis treatment: a systematic review and meta-analysis. Exp Ther Med. 2018;15:707–18. This meta-analysis included a total of 29 studies involving 4053 patients. The study concludes that assessing collateral circulation and penumbra area before thrombolytic therapy can help identify AIS patients who may benefit from treatment. Good collateral circulation is associated with improved outcomes, including functional recovery, reduced hemorrhagic complications, and lower mortality.PubMed
27.
go back to reference • Leng X, Lan L, Liu L, Leung TW, Wong KS. Good collateral circulation predicts favorable outcomes in intravenous thrombolysis: a systematic review and meta-analysis. Eur J Neurol. 2016;23:1738–49. In this meta-analysis were screened full-text articles published since 2000 focused on the overall effect sizes of good versus poor collateral status. Compared with poor pre-treatment collateral status, good collaterals showed a beneficial effect over the primary outcome of a favorable functional outcome at 3 or 6 months [RR, 2.45; 95% confidence interval, 1.94-3.09; P < 0.001] in acute ischaemic stroke patients receiving IVT treatment.PubMedCrossRef • Leng X, Lan L, Liu L, Leung TW, Wong KS. Good collateral circulation predicts favorable outcomes in intravenous thrombolysis: a systematic review and meta-analysis. Eur J Neurol. 2016;23:1738–49. In this meta-analysis were screened full-text articles published since 2000 focused on the overall effect sizes of good versus poor collateral status. Compared with poor pre-treatment collateral status, good collaterals showed a beneficial effect over the primary outcome of a favorable functional outcome at 3 or 6 months [RR, 2.45; 95% confidence interval, 1.94-3.09; P < 0.001] in acute ischaemic stroke patients receiving IVT treatment.PubMedCrossRef
28.
go back to reference Galego O, et al. Collateral pial circulation relates to the degree of brain edema on CT 24 hours after ischemic stroke. Neuroradiol J. 2018;31:456–63.PubMedPubMedCentralCrossRef Galego O, et al. Collateral pial circulation relates to the degree of brain edema on CT 24 hours after ischemic stroke. Neuroradiol J. 2018;31:456–63.PubMedPubMedCentralCrossRef
29.
go back to reference •• Seners P, et al. Better collaterals are independently associated with post-thrombolysis recanalization before thrombectomy. Stroke. 2019;50:867–72. This recent French study suggest that collateral imaging may be valuable in identifying patients who are more likely to benefit from IVT before thrombectomy, emphasizing the potential role of advanced imaging for personalized stroke therapy.PubMedCrossRef •• Seners P, et al. Better collaterals are independently associated with post-thrombolysis recanalization before thrombectomy. Stroke. 2019;50:867–72. This recent French study suggest that collateral imaging may be valuable in identifying patients who are more likely to benefit from IVT before thrombectomy, emphasizing the potential role of advanced imaging for personalized stroke therapy.PubMedCrossRef
30.
go back to reference Kim SJ, et al. A novel magnetic resonance imaging approach to collateral flow imaging in ischemic stroke. Ann Neurol. 2014;76:356–69.PubMedCrossRef Kim SJ, et al. A novel magnetic resonance imaging approach to collateral flow imaging in ischemic stroke. Ann Neurol. 2014;76:356–69.PubMedCrossRef
31.
go back to reference Zaidat OO, et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke. 2013;44:2650–63.PubMedPubMedCentralCrossRef Zaidat OO, et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke. 2013;44:2650–63.PubMedPubMedCentralCrossRef
32.
go back to reference • Weiss D, et al. Systematic evaluation of computed tomography angiography collateral scores for estimation of long-term outcome after mechanical thrombectomy in acute ischaemic stroke. Neuroradiol J. 2019;32:277–86. The study found very good inter-rater reliability for Modified Tan, Miteff, and Opercular Index Score ratio, and substantial reliability for Maas. The study concluded that computed tomography angiography scores are valuable for estimating functional outcomes after mechanical thrombectomy and are reliable across readers. The more complex scores, Maas and Miteff, demonstrated the best performance in predicting favorable outcomes.PubMedPubMedCentralCrossRef • Weiss D, et al. Systematic evaluation of computed tomography angiography collateral scores for estimation of long-term outcome after mechanical thrombectomy in acute ischaemic stroke. Neuroradiol J. 2019;32:277–86. The study found very good inter-rater reliability for Modified Tan, Miteff, and Opercular Index Score ratio, and substantial reliability for Maas. The study concluded that computed tomography angiography scores are valuable for estimating functional outcomes after mechanical thrombectomy and are reliable across readers. The more complex scores, Maas and Miteff, demonstrated the best performance in predicting favorable outcomes.PubMedPubMedCentralCrossRef
33.
go back to reference Yeo LLL, et al. Assessment of intracranial collaterals on CT angiography in anterior circulation acute ischemic stroke. Am J Neuroradiol. 2015;36:289–94.PubMedPubMedCentralCrossRef Yeo LLL, et al. Assessment of intracranial collaterals on CT angiography in anterior circulation acute ischemic stroke. Am J Neuroradiol. 2015;36:289–94.PubMedPubMedCentralCrossRef
34.
go back to reference Seker F, et al. Collateral scores in acute ischemic stroke : a retrospective study assessing the suitability of collateral scores as standalone predictors of clinical outcome. Clin Neuroradiol. 2020;30:789–93.PubMedCrossRef Seker F, et al. Collateral scores in acute ischemic stroke : a retrospective study assessing the suitability of collateral scores as standalone predictors of clinical outcome. Clin Neuroradiol. 2020;30:789–93.PubMedCrossRef
35.
go back to reference Tan BYQ, et al. Good intracranial collaterals trump poor ASPECTS (Alberta Stroke Program Early CT Score) for intravenous thrombolysis in anterior circulation acute ischemic stroke. Stroke. 2016;47:2292–8.PubMedCrossRef Tan BYQ, et al. Good intracranial collaterals trump poor ASPECTS (Alberta Stroke Program Early CT Score) for intravenous thrombolysis in anterior circulation acute ischemic stroke. Stroke. 2016;47:2292–8.PubMedCrossRef
36.
go back to reference Copelan A, et al. Opercular index score: a CT angiography-based predictor of capillary robustness and neurological outcomes in the endovascular management of acute ischemic stroke. J Neurointerventional Surg. 2017;9:1179–86.CrossRef Copelan A, et al. Opercular index score: a CT angiography-based predictor of capillary robustness and neurological outcomes in the endovascular management of acute ischemic stroke. J Neurointerventional Surg. 2017;9:1179–86.CrossRef
37.
go back to reference Al-Ali F, et al. The capillary index score in the IMS I. II trials Stroke J Cereb Circ. 2014;45:1999–2003.CrossRef Al-Ali F, et al. The capillary index score in the IMS I. II trials Stroke J Cereb Circ. 2014;45:1999–2003.CrossRef
38.
go back to reference •• Liebeskind DS, et al. Collaterals at angiography and outcomes in the Interventional Management of Stroke (IMS) III trial. Stroke. 2014;45:759–64. The IMS-3 is the largest prospective study evaluating the prognostic value of collateral circulation prior to thrombectomy, involving a significant number of patients. The findings indicate a substantial correlation between collateral circulation, the modified Rankin Scale (mRS), the National Institutes of Health Stroke Scale (NIHSS), and the Alberta Stroke Program Early CT Score (ASPECTS).PubMedPubMedCentralCrossRef •• Liebeskind DS, et al. Collaterals at angiography and outcomes in the Interventional Management of Stroke (IMS) III trial. Stroke. 2014;45:759–64. The IMS-3 is the largest prospective study evaluating the prognostic value of collateral circulation prior to thrombectomy, involving a significant number of patients. The findings indicate a substantial correlation between collateral circulation, the modified Rankin Scale (mRS), the National Institutes of Health Stroke Scale (NIHSS), and the Alberta Stroke Program Early CT Score (ASPECTS).PubMedPubMedCentralCrossRef
40.
go back to reference Saver JL, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372:2285–95.PubMedCrossRef Saver JL, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372:2285–95.PubMedCrossRef
41.
go back to reference • El Nawar R, et al. Higher annual operator volume is associated with better reperfusion rates in stroke patients treated by mechanical thrombectomy: the ETIS registry. JACC Cardiovasc Interv. 2019;12:385–91. This study aimed to determine whether individual operator characteristics affect reperfusion and procedural complication rates in mechanical thrombectomy (MT) for acute ischemic stroke (AIS). The study included 1,541 patients with anterior and posterior AIS (mean age 67 years, median NIHSS 16). he data indicate that the annual volume of MT procedures performed by an operator positively impacts successful reperfusion rates in AIS patients, but it does not affect clinical outcomes or complication rates.PubMedCrossRef • El Nawar R, et al. Higher annual operator volume is associated with better reperfusion rates in stroke patients treated by mechanical thrombectomy: the ETIS registry. JACC Cardiovasc Interv. 2019;12:385–91. This study aimed to determine whether individual operator characteristics affect reperfusion and procedural complication rates in mechanical thrombectomy (MT) for acute ischemic stroke (AIS). The study included 1,541 patients with anterior and posterior AIS (mean age 67 years, median NIHSS 16). he data indicate that the annual volume of MT procedures performed by an operator positively impacts successful reperfusion rates in AIS patients, but it does not affect clinical outcomes or complication rates.PubMedCrossRef
42.
go back to reference Liebeskind DS, et al. Collateral circulation in thrombectomy for stroke after 6 to 24 hours in the DAWN trial. Stroke. 2022;53:742–8.PubMedCrossRef Liebeskind DS, et al. Collateral circulation in thrombectomy for stroke after 6 to 24 hours in the DAWN trial. Stroke. 2022;53:742–8.PubMedCrossRef
43.
go back to reference Liebeskind DS, Jahan R, Nogueira RG, Zaidat OO, Saver JL. Impact of collaterals on successful revascularization in solitaire FR with the intention for thrombectomy. Stroke J Cereb Circ. 2014;45:2036–40.CrossRef Liebeskind DS, Jahan R, Nogueira RG, Zaidat OO, Saver JL. Impact of collaterals on successful revascularization in solitaire FR with the intention for thrombectomy. Stroke J Cereb Circ. 2014;45:2036–40.CrossRef
44.
go back to reference Anadani M, et al. Endovascular therapy of anterior circulation tandem occlusions: pooled analysis from the TITAN and ETIS registries. Stroke. 2021;52:3097–105.PubMedCrossRef Anadani M, et al. Endovascular therapy of anterior circulation tandem occlusions: pooled analysis from the TITAN and ETIS registries. Stroke. 2021;52:3097–105.PubMedCrossRef
45.
go back to reference •• Leng X, et al. Impact of collaterals on the efficacy and safety of endovascular treatment in acute ischaemic stroke: a systematic review and meta-analysis. J Neurol Neurosurg Psych. 2016;87:537–44. This recent meta-analysis encompasses 39 studies and demonstrates that patients with robust collateral circulation undergoing thrombectomy have a threefold higher likelihood of achieving a favorable functional outcome at 3 months.CrossRef •• Leng X, et al. Impact of collaterals on the efficacy and safety of endovascular treatment in acute ischaemic stroke: a systematic review and meta-analysis. J Neurol Neurosurg Psych. 2016;87:537–44. This recent meta-analysis encompasses 39 studies and demonstrates that patients with robust collateral circulation undergoing thrombectomy have a threefold higher likelihood of achieving a favorable functional outcome at 3 months.CrossRef
46.
go back to reference Bornstein NM, et al. An injectable implant to stimulate the sphenopalatine ganglion for treatment of acute ischaemic stroke up to 24 h from onset (ImpACT-24B): an international, randomised, double-blind, sham-controlled, pivotal trial. Lancet Lond Engl. 2019;394:219–29.CrossRef Bornstein NM, et al. An injectable implant to stimulate the sphenopalatine ganglion for treatment of acute ischaemic stroke up to 24 h from onset (ImpACT-24B): an international, randomised, double-blind, sham-controlled, pivotal trial. Lancet Lond Engl. 2019;394:219–29.CrossRef
47.
go back to reference Malhotra K, et al. Association of statin pretreatment with collateral circulation and final infarct volume in acute ischemic stroke patients: a meta-analysis. Atherosclerosis. 2019;282:75–9.PubMedCrossRef Malhotra K, et al. Association of statin pretreatment with collateral circulation and final infarct volume in acute ischemic stroke patients: a meta-analysis. Atherosclerosis. 2019;282:75–9.PubMedCrossRef
48.
go back to reference Charriaut-Marlangue C, et al. Inhaled nitric oxide reduces brain damage by collateral recruitment in a neonatal stroke model. Stroke. 2012;43:3078–84.PubMedCrossRef Charriaut-Marlangue C, et al. Inhaled nitric oxide reduces brain damage by collateral recruitment in a neonatal stroke model. Stroke. 2012;43:3078–84.PubMedCrossRef
49.
go back to reference Terpolilli NA, et al. Inhalation of nitric oxide prevents ischemic brain damage in experimental stroke by selective dilatation of collateral arterioles. Circ Res. 2012;110:727–38.PubMedCrossRef Terpolilli NA, et al. Inhalation of nitric oxide prevents ischemic brain damage in experimental stroke by selective dilatation of collateral arterioles. Circ Res. 2012;110:727–38.PubMedCrossRef
50.
go back to reference van den Berg SA, et al. Prehospital transdermal glyceryl trinitrate in patients with presumed acute stroke (MR ASAP): an ambulance-based, multicentre, randomised, open-label, blinded endpoint, phase 3 trial. Lancet Neurol. 2022;21:971–81.PubMedCrossRef van den Berg SA, et al. Prehospital transdermal glyceryl trinitrate in patients with presumed acute stroke (MR ASAP): an ambulance-based, multicentre, randomised, open-label, blinded endpoint, phase 3 trial. Lancet Neurol. 2022;21:971–81.PubMedCrossRef
51.
go back to reference Desai SM, Jha RM, Linfante I. Collateral circulation augmentation and neuroprotection as adjuvant to mechanical thrombectomy in acute ischemic stroke. Neurol. 2021;97:S178–84. Desai SM, Jha RM, Linfante I. Collateral circulation augmentation and neuroprotection as adjuvant to mechanical thrombectomy in acute ischemic stroke. Neurol. 2021;97:S178–84.
52.
go back to reference de Havenon A, et al. Results from DEFUSE 3: good collaterals are associated with reduced ischemic core growth but not neurologic outcome. Stroke. 2019;50:632–8.PubMedPubMedCentralCrossRef de Havenon A, et al. Results from DEFUSE 3: good collaterals are associated with reduced ischemic core growth but not neurologic outcome. Stroke. 2019;50:632–8.PubMedPubMedCentralCrossRef
53.
go back to reference Rao VL, et al. Collateral status contributes to differences between observed and predicted 24-h infarct volumes in DEFUSE 3. J Cereb Blood Flow Metab. 2020;40:1966–74.PubMedPubMedCentralCrossRef Rao VL, et al. Collateral status contributes to differences between observed and predicted 24-h infarct volumes in DEFUSE 3. J Cereb Blood Flow Metab. 2020;40:1966–74.PubMedPubMedCentralCrossRef
Metadata
Title
Delving Into the Significance of Brain’s Collateral Circulation in the Era of Revascularization Therapy
Authors
Marilena Mangiardi, MD
Sergio Soeren Rossi, MD
Adriano Bonura, MD
Gianmarco Iaccarino, MD
Michele Alessiani, MD
Sabrina Anticoli, MD
Gianluca De Rubeis, MD
Enrico Pampana, MD
Francesca Romana Pezzella, MD
Publication date
04-05-2024
Publisher
Springer US
Published in
Current Treatment Options in Neurology
Print ISSN: 1092-8480
Electronic ISSN: 1534-3138
DOI
https://doi.org/10.1007/s11940-024-00794-7