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Collateral Blood Flow and Ischemic Core Growth

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Abstract

Treatment of a large vessel occlusion in the acute ischemic stroke setting focuses on vessel recanalization, and endovascular thrombectomy results in favorable outcomes in appropriate candidates. Expeditious treatment is imperative, but patients often present to institutions that do not have neurointerventional surgeons and need to be transferred to a comprehensive stroke center. These treatment delays are common, and it is important to identify factors that mitigate the progression of the ischemic core in order to maximize the preservation of salvageable brain tissue. Collateral blood flow is the strongest factor known to influence ischemic core growth, which includes the input arterial vessels, tissue-level vessels, and venous outflow. Collateral blood flow at these different levels may be imaged by specific imaging techniques that may also predict ischemic core growth during treatment delays and help identify patients who would benefit from transfer and endovascular therapy, as well as identify those patients in whom transfer may be futile. Here we review collateral blood flow and its relationship to ischemic core growth in stroke patients.

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Authors and Affiliations

  1. Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA

    Kimberly Seifert & Jeremy J. Heit

  2. Radiology and Neurosurgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA

    Jeremy J. Heit

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  1. Kimberly Seifert
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Correspondence to Jeremy J. Heit.

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Dr. Heit is a consultant for Medtronic and MicroVention and a member of the medical and scientific advisory board for iSchemaView.

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Seifert, K., Heit, J.J. Collateral Blood Flow and Ischemic Core Growth. Transl. Stroke Res. 14, 13–21 (2023). https://doi.org/10.1007/s12975-022-01051-2

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