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Related Experiment Video

Updated: Mar 24, 2026

A Fibrin-Enriched and tPA-Sensitive Photothrombotic Stroke Model

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Facing Time in Ischemic Stroke: An Alternative Hypothesis for Collateral Failure.

M Pham¹, M Bendszus²

¹Department of Neuroradiology, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany. mirko.pham@med.uni-heidelberg.de.

Clinical Neuroradiology

|March 9, 2016

Summary

This summary is machine-generated.

Endovascular recanalization effectively treats ischemic stroke from large artery occlusion. Collateral blood flow significantly impacts patient outcomes, though its exact role in stroke progression requires further investigation.

Keywords:

acute therapy collaterals endovascular recanalization ischemic stroke macrovascular microvascular

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Area of Science:

Neurology
Vascular Medicine
Interventional Neuroradiology

Background:

Ischemic stroke due to large cerebral artery occlusion is treatable with endovascular recanalization.
Studies like ESCAPE highlight the link between pre-recanalization collateral flow and clinical outcomes.
Collateral circulation is vital for sustaining the ischemic penumbra.

Purpose of the Study:

To review data associating macrovascular pial collateral flow with clinical outcomes after endovascular recanalization.
To explore the role of collateral flow in stroke progression and recanalization success.
To present an alternative hypothesis regarding the cause of collateral failure.

Main Methods:

Review of randomized-controlled trials and clinical data, including the ESCAPE study.
Analysis of imaging techniques like Digital Subtraction Angiography (DSA) and CT Angiography (CTA) for assessing collateral filling.
Discussion of clinical observations linking collateral status to stroke progression.

Main Results:

Strong association confirmed between pre-recanalization collateral flow and post-recanalization clinical outcomes.
Poor collateral filling appears linked to rapid infarction and unsuccessful recanalization.
The precise cause-effect relationship between collateral failure and poor outcomes remains debated.

Conclusions:

Macrovascular collateral flow is a critical determinant of outcome in endovascular stroke treatment.
While poor collaterals may indicate a poor prognosis, their role as a primary cause of infarction is questioned.
An alternative hypothesis suggests collateral collapse may be a secondary consequence of microvascular changes during infarction.