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Published on: August 11, 2023
Arterial Steal to the Penumbra Area in Patients with Acute MCA Occlusion: A Quantitative Angiographic Analysis
René van den Berg1, Jenna J Wildeman2, Olvert A Berkhemer1
1Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (AMC), Amsterdam, The Netherlands.
Purpose:
In acute middle cerebral artery (MCA) occlusion, collateral vessels provide retrograde supply to the occluded territory. We hypothesized that such collateral flow reduces perfusion of the non-occluded donor region (steal effect).
Materials And Methods:
Patients with an MCA occlusion with opacification of both ipsi- and contralateral anterior cerebral arteries (ACA) on angiography prior to endovascular treatment were selected. Arteriovenous transit time (AVTT) for both ACA territories was compared for different grades of collateral supply to the MCA territory. In addition, the influence of diabetes and hypertension was analyzed. After successful revascularization, AVTT was re-assessed to determine reversibility.
Results:
Forty-one patients were analyzed. An AVTT of 8.6 seconds (standard deviation [SD] 2.4 seconds) was seen in the ACA territory of the affected hemisphere in comparison to 6.6 seconds (SD 2.1 seconds) for the contralateral side (P<0.001). A more prolonged (but not significant) AVTT was seen in cases with a higher collateral grade. No difference in AVTT was seen in patients with diabetes or hypertension. After successful MCA revascularization, AVTT delay was 7.4 seconds (SD 2.1 seconds).
Conclusion:
A cerebral steal effect occurs in patients with an acute MCA occlusion, probably related to augmented flow to the penumbra area.
Insights
In acute middle cerebral artery (MCA) occlusion, collateral blood flow to the affected area may reduce blood supply to healthy brain regions, causing a "steal effect." This phenomenon was observed in patients undergoing endovascular treatment.
Area of Science:
- Neuroscience
- Cerebrovascular Medicine
- Radiology
Background:
- Collateral vessels are crucial for maintaining blood supply to ischemic brain regions during acute middle cerebral artery (MCA) occlusion.
- The potential impact of collateral flow on non-occluded donor regions, known as the
- steal effect,
- has been a subject of investigation.
Purpose of the Study:
- To investigate the hypothesis that collateral blood flow to the occluded MCA territory reduces perfusion in the non-occluded donor region.
- To quantify the cerebral steal effect in patients with acute MCA occlusion.
Main Methods:
- Retrospective analysis of 41 patients with MCA occlusion and opacification of both anterior cerebral arteries (ACAs) on pre-treatment angiography.
- Comparison of arteriovenous transit time (AVTT) in ipsilateral and contralateral ACA territories based on collateral supply grade.
- Assessment of the influence of diabetes and hypertension.
- Re-assessment of AVTT after successful revascularization to determine reversibility.
Main Results:
- Patients exhibited a significantly longer AVTT in the affected ACA territory (8.6 seconds) compared to the contralateral side (6.6 seconds).
- A trend towards prolonged AVTT was observed with higher collateral grades, though not statistically significant.
- No significant differences in AVTT were found in patients with diabetes or hypertension.
- Following successful revascularization, AVTT delay averaged 7.4 seconds.
Conclusions:
- Evidence supports the occurrence of a cerebral steal effect in acute MCA occlusion.
- This steal effect is likely associated with increased blood flow directed to the penumbra (at-risk brain tissue) via collateral pathways.
