Collateral blood vessels in acute ischemic stroke: a physiological window to predict future outcomes

Heitor Castelo Branco Rodrigues Alves; Felipe Torres Pacheco; Antonio J. Rocha

doi:10.1590/0004-282X20160050

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(08): 662-670
DOI: 10.1590/0004-282X20160050

REVIEW

Collateral blood vessels in acute ischemic stroke: a physiological window to predict future outcomes

Circulação colateral no acidente vascular cerebral isquêmico: uma janela fisiológica para prever resultados futuros

Heitor Castelo Branco Rodrigues Alves

¹Santa Casa de São Paulo, Faculdade de Ciências Médicas, Divisao de Neuroradiologia, São Paulo SP, Brasil; Fleury Medicina e Saúde, Divisao de Neuroradiologia, São Paulo SP, Brasil.

²Fleury Medicina e Saúde, Divisao de Neuroradiologia São Paulo SP, Brasil

,

Felipe Torres Pacheco

¹Santa Casa de São Paulo, Faculdade de Ciências Médicas, Divisao de Neuroradiologia, São Paulo SP, Brasil; Fleury Medicina e Saúde, Divisao de Neuroradiologia, São Paulo SP, Brasil.

²Fleury Medicina e Saúde, Divisao de Neuroradiologia São Paulo SP, Brasil

,

Antonio J. Rocha

¹Santa Casa de São Paulo, Faculdade de Ciências Médicas, Divisao de Neuroradiologia, São Paulo SP, Brasil; Fleury Medicina e Saúde, Divisao de Neuroradiologia, São Paulo SP, Brasil.

²Fleury Medicina e Saúde, Divisao de Neuroradiologia São Paulo SP, Brasil

› Author Affiliations

Abstract

ABSTRACT

Collateral circulation is a physiologic pathway that protects the brain against ischemic injury and can potentially bypass the effect of a blocked artery, thereby influencing ischemic lesion size and growth. Several recent stroke trials have provided information about the role of collaterals in stroke pathophysiology, and collateral perfusion has been recognized to influence arterial recanalization, reperfusion, hemorrhagic transformation, and neurological outcomes after stroke. Our current aim is to summarize the anatomy and physiology of the collateral circulation and to present and discuss a comprehensible review of the related knowledge, particularly the effects of collateral circulation on the time course of ischemic injury and stroke severity, as well as imaging findings and therapeutic implications.

RESUMO

A circulação colateral é um circuito fisiológico de proteção contra alterações isquêmicas que, potencialmente, evita os efeitos de uma oclusão arterial e com isso pode influenciar nas dimensões e no crescimento de uma lesão isquêmica. Vários estudos recentes forneceram informações a respeito do papel das colaterais na fisiopatologia do acidente vascular encefálico isquêmico e demonstraram a capacidade da circulação colateral de influenciar as taxas de reperfusão, recanalização, transformação hemorrágica e com isso desfecho clínico dos pacientes. O objetivo desta revisão é sintetizar a anatomia e a fisiologia da circulação colateral encefálica, apresentando e discutindo, o que se conhece atualmente acerca do seu efeito na cronologia e gravidade da lesão isquêmica, além dos achados de imagens e implicações terapêuticas.

stroke - brain schemia - collateral circulation - tomography - angiography - perfusion

acidente vascular cerebral - isquemia encefálica - circulação colateral - tomografia - angiografia - perfusão

Full Text

References

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