Related Experiment Video

Updated: Jul 15, 2026

Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
07:46

Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia

Published on: May 9, 2013

29.2K

Impact of cerebral collateral flow on stroke outcomes after carotid stenting

Liang-Ju Chen1, Chi-Kuang Liu2, Shih-Chun Wang2

  • 1Department of Health Business Administration, Hungkuang University, Taichung City, Taiwan.

Annals of Clinical and Translational Neurology
|September 2, 2023
PubMed

Insights

Changes in anterior circulation flow direction (ACFDC) and reversal of ophthalmic artery/leptomeningeal anastomosis (ROALA) predict recurrent stroke after carotid stenting. Prestenting imaging is crucial for outcome prediction in patients with internal carotid artery stenosis.

Area of Science:

  • Neuroscience
  • Vascular Surgery
  • Radiology

Background:

  • Internal carotid artery stenosis is a primary cause of recurrent ischemic stroke.
  • Understanding collateral circulation dynamics is vital for predicting stroke recurrence.
  • Carotid stenting is a common intervention for managing carotid artery stenosis.

Purpose of the Study:

  • To evaluate the association between recurrent stroke and changes in prestenting collateral flow direction.
  • To investigate the interaction between extra- and intracranial arteries in predicting stroke recurrence.
  • To determine the predictive value of anterior circulation flow direction change (ACFDC) and reversal of ophthalmic artery/leptomeningeal anastomosis (ROALA) for recurrent stroke.

Main Methods:

  • A longitudinal study of 234 stroke patients undergoing carotid stenting.
  • Assessment of ACFDC and ROALA using transcranial color-coded duplex (TCCD) before stenting.
  • Recurrent stroke as the main outcome, analyzed using Kaplan-Meier plots and Cox regression over a 9-year follow-up.

Main Results:

  • Recurrent stroke occurred in 115 patients.
  • Left ACFDC and ROALA were associated with significantly worse outcomes compared to ACFDC alone.
  • Left ACFDC indicated a worse outcome than right ACFDC (p < 0.001).
  • ACFDC on the right, left, or both sides significantly increased the risk of recurrent stroke (HR > 20, p < 0.01).

Conclusions:

  • Anterior circulation flow direction change is a significant predictor of recurrent stroke in patients with unilateral carotid stenosis.
  • The combined presence of ACFDC and ROALA indicates a poorer prognosis.
  • Pre-stenting TCCD imaging provides critical information for predicting outcomes after carotid stenting.
Abstract

More Related Videos

Middle Cerebral Artery Occlusion Allowing Reperfusion via Common Carotid Artery Repair in Mice06:59

Middle Cerebral Artery Occlusion Allowing Reperfusion via Common Carotid Artery Repair in Mice

Published on: January 23, 2019

17.8K
A Fibrin-Enriched and tPA-Sensitive Photothrombotic Stroke Model09:42

A Fibrin-Enriched and tPA-Sensitive Photothrombotic Stroke Model

Published on: June 4, 2021

2.8K

Related Concept Videos

Ischemic Stroke l: Introduction01:15

Ischemic Stroke l: Introduction

Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
Ischemic Stroke ll: Pathophysiology01:15

Ischemic Stroke ll: Pathophysiology

An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...