Pattern of collaterals, type of infarcts, and haemodynamic impairment in carotid artery occlusion

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A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
09:36

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis

Published on: August 12, 2025

H Yamauchi1, T Kudoh, K Sugimoto

  • 1Research Institute, Shiga Medical Center, Moriyama City, Shiga, Japan. yamauchi@shigamed.jp

Journal of Neurology, Neurosurgery, and Psychiatry
|November 19, 2004
PubMed

Insights

In internal carotid artery (ICA) occlusion, ophthalmic or leptomeningeal collaterals and lack of striatocapsular infarcts predict higher oxygen extraction fraction (OEF). This suggests collateral patterns and infarct types impact hemodynamic impairment severity.

Area of Science:

  • Neuroscience
  • Radiology
  • Vascular Neurology

Background:

  • Internal carotid artery (ICA) occlusion can lead to inadequate collateral blood flow, indicated by increased oxygen extraction fraction (OEF).
  • The Circle of Willis, ophthalmic artery, and leptomeningeal vessels serve as collateral pathways.
  • Ischemic lesions can reduce metabolic demand, affecting collateral flow adequacy.

Purpose of the Study:

  • To identify independent predictors of OEF in patients with ICA occlusion.
  • To investigate the relationship between collateral pathway patterns, infarct types, and OEF.

Main Methods:

  • Studied 42 patients with symptomatic ICA occlusion.
  • Assessed collateral pathways (Willisian, ophthalmic, leptomeningeal) using four-vessel angiography.
  • Categorized infarcts via MRI and measured hemispheric OEF using positron emission tomography.

Main Results:

  • Multivariate analysis revealed ophthalmic or leptomeningeal collaterals as predictors of increased OEF.
  • Absence of striatocapsular infarcts was also an independent predictor of increased OEF.
  • These findings highlight specific collateral patterns and infarct types associated with hemodynamic impairment.

Conclusions:

  • Collateral pathway patterns influence the supply of blood flow in ICA occlusion.
  • Infarct types affect brain metabolic demand, impacting hemodynamic impairment.
  • Both factors are crucial in determining the severity of hemodynamic impairment in symptomatic ICA occlusion.
Abstract

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