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The Pathophysiology of Collateral Circulation in Acute Ischemic Stroke

Marilena Mangiardi1, Adriano Bonura2, Gianmarco Iaccarino2

  • 1Department of Stroke Unit, San Camillo-Forlanini Hospital, 00152 Rome, Italy.

Diagnostics (Basel, Switzerland)
|July 29, 2023
PubMed

Cerebral collateral circulation is a network of blood vessels which stabilizes blood flow and maintains cerebral perfusion whenever the main arteries fail to provide an adequate blood supply, as happens in ischemic stroke. These arterial networks are able to divert blood flow to hypoperfused cerebral areas. The extent of the collateral circulation determines the volume of the salvageable tissue, the so-called "penumbra". Clinically, this is associated with greater efficacy of reperfusion therapies (thrombolysis and thrombectomy) in terms of better short- and long-term functional outcomes, lower incidence of hemorrhagic transformation and of malignant oedema, and smaller cerebral infarctions. Recent advancements in brain imaging techniques (CT and MRI) allow us to study these anastomotic networks in detail and increase the likelihood of making effective therapeutic choices. In this narrative review we will investigate the pathophysiology, the clinical aspects, and the possible diagnostic and therapeutic role of collateral circulation in acute ischemic stroke.

Keywords:
acute ischemic strokeanterior brain circulationcollateral circulationsintravenous thrombolysispenumbraposterior brain circulationthrombectomy

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