2021/06/10 by Martina Sebök, Christiaan Hendrik Bas van Niftrik, Niklas Lohaus +6 · 1 citation
Medicine · #Cerebrovascular and Carotid Artery Diseases #Acute Ischemic Stroke Management #Advanced MRI Techniques and Applications #Medicine #Occlusion #Cardiology #Collateral circulation #Internal medicine #Stroke (engine) #Internal carotid artery #Middle cerebral artery #Radiology #Ischemia
paper · pdf · doi:10.1177/0271678x211024373
openalex publication_date 2021/06/10 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/05
For patients with symptomatic unilateral internal carotid artery (ICA) occlusion, impaired cerebrovascular reactivity (CVR) indicates increased stroke risk. Here, the role of collateral activation remains a matter of debate, whereas angio-anatomical collateral abundancy does not necessarily imply sufficient compensatory flow provided. We aimed to further elucidate the role of collateral activation in the presence of impaired CVR. From a prospective database, 62 patients with symptomatic unilateral ICA occlusion underwent blood oxygenation-level dependent (BOLD) fMRI CVR imaging and a transcranial Doppler (TCD) investigation for primary and secondary collateral activation. Descriptive statistic and multivariate analysis were used to evaluate the relationship between BOLD-CVR values and collateral activation. Patients with activated secondary collaterals exhibited more impaired BOLD-CVR values of the ipsilateral hemisphere (p = 0.02). Specifically, activation of leptomeningeal collaterals showed severely impaired ipsilateral hemisphere BOLD-CVR values when compared to activation of ophthalmic collaterals (0.05 ± 0.09 vs. 0.12 ± 0.04, p = 0.005). Moreover, the prediction analysis showed leptomeningeal collateral activation as a strong independent predictor for ipsilateral hemispheric BOLD-CVR. In our study, ipsilateral leptomeningeal collateral activation is the sole collateral pathway associated with severely impaired BOLD-CVR in patients with symptomatic unilateral ICA occlusion.