Abstract T P88: Impaired Collateral Status During Unilateral Carotid Occlusion In Type 2 Diabetic Mice

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Yasuo Nishijima ◽  
Yosuke Akamtsu ◽  
Chih Cheng Lee ◽  
Jialing Liu
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Artery Occlusion ◽  
Circle Of Willis ◽  
Carotid Occlusion ◽  
Collateral Flow ◽  
Time Points ◽  
Increased Risk ◽  
Retrograde Filling

Introduction: Type 2 diabetes mellitus (T2DM) is major risk factor of ischemic stroke and is associated with poor outcome after stroke. Previously we found that T2DM mice exhibited impaired leptomeningeal collateral flow recruitment after distal middle cerebral artery occlusion (MCAO). The current study aimed to study the collateral status during unilateral carotid occlusion, commonly observed in human patients with atherosclerosis. Methods: Adult male db/db and db/+ mice were subjected to permanent unilateral common carotid artery occlusion (CCAO) to simulate the hypoperfusion state in the human carotid artery disease. In vivo imaging of blood flow and flow velocity of the leptomeningeal collateral vessels was performed at various time points after CCAO with doppler optical coherence tomography (DOCT). Diameter of each major artery in the circle of Willis was also quantified by DiI-labeling at various time points after CCAO. Results: Imaging of DOCT showed that during occlusion of CCA, db/+ mice showed more robust retrograde filling of several distal branches of the MCA from ACA immediately and 24 hours after CCAO compared to db/db mice. Data with DiI-labeling showed that in both strains, the diameters of Willis ring including ICA, MCA, ACA gradually enlarged after 24 hours following CCAO. However the diameters of these vessels of db/db mice on the ischemic side were significantly smaller at 24 hours and 7 days after CCAO compared to that of db/+ mice. Conclusion: Our results demonstrate an impairment of leptomeningeal collateral recruitment and a deficiency in collateral vessel growth in the circle of Willis after CCAO in db/db mice. These findings might underlie the increased risk of ischemic injury in T2DM patients with carotid disease or stroke.

Abstract WP436: Reduced Blood Flow in the Pial Collaterals and Penetrating Arterioles During Chronic Hypoperfusion in Type 2 Diabetic Mice

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Yasuo Nishijima ◽  
Yosuke Akamatsu ◽  
Atsushi Kanoke ◽  
Shih Y Yang ◽  
Teiji Tominaga ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Circle Of Willis ◽  
Cerebral Hypoperfusion ◽  
Additional Risk Factor ◽  
Collateral Flow

Introduction: The degree of cortical hypoperfusion following carotid steno-occlusion depends on the dynamic compensation from the collateral circulation. The presence of collaterals is associated with a reduced risk of stroke and transient ischemic attack (TIA) in patients with steno-occlusive carotid artery disease. Although metabolic syndrome negatively impacts collateral status among patients with ischemic stroke, it is unclear whether type 2 diabetes (T2DM) specifically affects leptomeningeal collateral flow regulation and the adaptation of collateral vessels at the circle of Willis during hypoperfusion. Methods: Spatial and temporal changes of the leptomeningeal collateral flow and the flow dynamics of the penetrating arterioles in the distal MCA and ACA branches over two weeks following unilateral common carotid artery occlusion (CCAO) were determined by optical coherent tomography in db/+ and db/db mice, a mouse model for obesity and type 2 diabetes. The temporal adaptation of the circle of Willis (CW) following CCAO was assessed by measuring CW vessel diameters. Results: Following unilateral CCAO, db/db mice exhibited diminished leptomeningeal collateral flow compensation compared to db /+ mice, which coincided with a reduced dilation of distal ACA branches, leading to reduced flow not only in pial vessels, but also in penetrating arterioles bordering the distal MCA and ACA. However, no apparent cell death was detected in either strain of mice during the first week after CCAO. db/db mice also experienced a more severe early reduction in the vessel diameters of several ipsilateral main feeding arteries in the CW, in addition to a delayed post-CCAO adaptive response by one to two weeks compared to db/+ mice. Conclusions: T2DM is an additional risk factor for hemodynamic compromise during cerebral hypoperfusion, which may increase the severity and the risk of stroke or TIA.

Abstract WP33: Reperfusion Therapy in Carotid Artery Occlusion with Collaterals Through the Circle of Willis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Seong Hwan Ahn ◽  
In Sung Choo ◽  
Hyun Gu Kang ◽  
Ji Yeon Jung ◽  
Sang Woo Ha
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Recurrent Stroke ◽  
Reperfusion Therapy ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Circle Of Willis ◽  
Carotid Occlusion ◽  
Large Artery ◽  
Clinical Worsening

Introduction: In large artery occlusion, endovascular treatment shows better recanalization rate than intravenous tPA alone. In reperfusion therapy, excellent collaterals through the circle of Willis has better prognosis. We hypothesized that intravenous tPA only is comparable to endovascular therapy in carotid occlusion with patent ‘T’. Methods: Between January 2010 and December 2015, in acute stroke patients who had received a reperfusion therapy, carotid artery occlusion with good collateral via the circle of Willis were selected. In all patients, non-contrast CT and CT angiography were conducted before reperfusion therapy and at 24 (+/-6) hours and/or clinical worsening. Stroke severity was assessed with NIHSS at baseline and discharge. The prognosis of reperfusion therapy was assessed by modified Rankin Scales at 3 months. Results: In 529 patients treated by reperfusion therapy, 29 patients (5.5%, male 21, median age 76) had internal carotid artery occlusion with patent ‘T’. In tPA alone (24 patients, 82.8%), baseline NIHSS were non-significantly lower than in endovascular treatment (10 vs 15, p=0.224). Recurrent stroke, which was confirmed with follow up angiography, was developed in 8 of tPA alone. In endovascular treatment, one had a distal embolization. In 22 patients who could be assessed by MRS, 10 patients (45.5%, tPA in 9, IA in 1) had good mRS and 6 patients (27.3%) were expired. Conclusions: Carotid occlusion with good collaterals via the circle of Willis was uncommon. tPA alone resulted in recurrent stroke with clinical worsening. Endovascular treatment may be better option in carotid occlusion with patent ‘T’.

scholarly journals Circle of Willis Collateral Flow in Carotid Artery Occlusion Is Depicted by 4D-CTA

2018 ◽  
Vol 114 ◽  
pp. 421-426.e1 ◽  
Author(s):  
Midas Meijs ◽  
Frank-Erik de Leeuw ◽  
Hieronymus D. Boogaarts ◽  
Rashindra Manniesing ◽  
Frederick Jan Anton Meijer
Keyword(s):  
Carotid Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Circle Of Willis ◽  
Collateral Flow

Transcranial Doppler Ultrasound as a Guide to Graded Therapeutic Occlusion of the Carotid Artery

Neurosurgery ◽  
1990 ◽  
Vol 26 (2) ◽  
pp. 307-311 ◽  
Author(s):  
Cole A. Giller ◽  
Phillip Steig ◽  
Hunt H. Batjer ◽  
Duke Samson ◽  
Phillip Purdy
Keyword(s):  
Carotid Artery ◽  
Doppler Ultrasound ◽  
Transcranial Doppler ◽  
Giant Aneurysm ◽  
Transcranial Doppler Ultrasound ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Carotid Occlusion ◽  
Collateral Flow ◽  
Therapeutic Occlusion

Abstract Although gradual carotid artery occlusion is an accepted and effective treatment for some surgically inaccessible intracranial aneurysms, there are no specific guidelines to determine the optimal amount of carotid artery narrowing at each adjustment. The technique of transcranial Doppler ultrasound, however, allows continuous measurement of blood velocity in the middle cerebral artery as the carotid artery is narrowed, so that hemodynamic effects and development of collateral flow can be immediately assessed at the bedside at each adjustment of the carotid artery diameter. This case report describes the use of transcranial Doppler to guide the rate of carotid occlusion in a patient with an unclippable giant aneurysm of the carotid artery. Sudden carotid occlusion and gradual occlusion at the usual rate were not tolerated by the patient. but repeatedly tightening the clamp until the first signs of attenuation of the Doppler signal allowed an expedient occlusion without complication. Transcranial Doppler ultrasound can provide a useful dynamic guide to gradual therapeutic carotid occlusion.

scholarly journals Incomplete circle of Willis and cerebrovascular reactivity in asymptomatic patients before and after carotid endarterectomy

2020 ◽  
pp. 68-68
Author(s):  
Vladimir Manojlovic ◽  
Djordje Milosevic ◽  
Nebojsa Budakov ◽  
Dragan Nikolic
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Disease ◽  
Circle Of Willis ◽  
Cerebrovascular Reactivity ◽  
Collateral Flow ◽  
Apnea Test ◽  
Asymptomatic Patients ◽  
Before And After ◽  
Artery Disease

Introduction/Objective. Circle of Willis (CoW) provides the most significant collateral flow in the presence of significant stenosis or occlusion of internal carotid artery. In terms of collateral flow ?incomplete? type and ?complete? type of CoW can be recognized. Patients with carotid artery disease with incomplete CoW have lower cerebrovascular reactivity and higher risk for stroke. Cerebrovascular reactivity refers to the residual capacity of dilatation of cerebral blood vessels in the condition of insufficient blood flow. In this study we analyzed changes in cerebrovascular reactivity after carotid endarterectomy in asymptomatic patients with respect to complete and incomplete CoW morphology. Methods. In this study in 97 patients with asymptomatic carotid artery disease we measured cerebrovascular reactivity before and after carotid endarterectomy by using method of ?apnea test? and ? Breath Hold Index? (BHI). Patients were divided into two following groups: patients with ?complete? CoW and ?incomplete? CoW based on non-contrast magnetic resonance angio performed previously to the operation. Descriptive statistics, univariate analysis, and ANOVA for comparison of BHI values between groups were used. Results. Results showed significant increase in cerebrovascular reactivity at the side of stenosis in both groups of patients with complete CoW (BHI value increased from 0,897 to 1.090; F(1.65) = 30.788, p < 0.0005, parc. ?2 = 0.321) and incomplete CoW (BHI value increased from 0.690 to 1.010; F ( 1.27 ) = 62.318 , p < 0.0005, parc. ?2 = 0.698) and the more significant increase in the group of incomplete CoW compared to the group with complete CoW (F (1.92 ) = 4.557 , p =0.035 , parc. ?2 =0.047) Conclusion. In most asymptomatic patients, cerebrovascular reactivity restores to normal following carotid endarterectomy. Parameters of cerebrovascular reactivity are lower in patients with incomplete CoW and the increase after carotid endarterectomy is more significant in such patients.

CAROTID-ARTERY DISEASE AND RETINAL-ARTERY OCCLUSION

The Lancet ◽  
1979 ◽  
Vol 313 (8125) ◽  
pp. 1084 ◽  
Author(s):  
RobertL Tomsak ◽  
Maurice Hanson ◽  
FroncieA Gutman
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Retinal Artery ◽  
Artery Disease

Abstract T P83: Strain Differences In Leptomeningeal Collateral Flow Dynamics Correlate With Differences In Stroke Outcome

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Yasuo Nishijima ◽  
Yosuke Akamtsu ◽  
Chih Cheng Lee ◽  
Jialing Liu
Keyword(s):  
Blood Flow ◽  
Acute Phase ◽  
Collateral Circulation ◽  
Artery Occlusion ◽  
Flow Dynamics ◽  
Mouse Strains ◽  
Collateral Flow ◽  
Doppler Flowmetry ◽  
Collateral Arteries ◽  
Retrograde Filling

Introduction: Emerging evidences suggest that the collateral circulation plays a key role in the risk of stroke and the severity of infarction. The current study aimed to investigate the effect of the brain collateral circulation in acute phase of stroke and outcome in two inbred mouse strains that differ markedly in anatomical collateralization. Methods: Male C57BL/6 and Balb/C mice were subjected to permanent unilateral common carotid artery occlusion (CCAO) or temporary distal middle cerebral artery occlusion (dMCAo). Regional cerebral blood flow (rCBF) was assessed by laser doppler flowmetry. In vivo imaging of collateral blood flow and flow velocity was evaluated by doppler optical coherence tomography (DOCT). Infarct size and motor function was assessed at 24 hours and 1 week after dMCAo, respectively. DiI-labeling was used to reveal anastomoses and to determine vessel diameter. Results: The diameters of the ICA and ACA on the ischemic side in both strains markedly decreased at 24 hours after CCAO but recovered at 7 days, although the diameters of ICA, MCA and ACA are larger in the Balb/C compared to the C57BL/6 strain before and after CCAO. Balb/C mice exhibited significantly less leptomeningeal connecting collateral arteries compared to C57BL/6 (0.6±0.3 vs 11.3±0.4, p<0.001), coincided with a larger infarction and worse neurological outcomes after dMCAo compared to C57BL/6. During the acute phase of occlusion of the CCA or MCA, C57BL/6 mice also demonstrated a much more robust retrograde filling of several distal branches of the MCA from ACA compared to Balb/C mice. Conclusion: Our results demonstrate that anatomical insufficiency of the leptomeningeal collateralization is associated with an impaired collateral flow dynamics, resulting in reduced rCBF during the acute phase of MCA stroke, which might in part, contribute to the larger infarction observed in the Balb/C strain.

Abstract WP150: BeamSAT MRI Help to Identify Patients at Risk for Intolerance to Temporary Internal Carotid Artery Occlusion During CEA and CAS

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jun Tanaka ◽  
Kohkichi Hosoda ◽  
Yusuke Yamamoto ◽  
Taichiro Imahori ◽  
Atsushi Fujita ◽  
...  
Keyword(s):  
At Risk ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Preoperative Assessment ◽  
Contralateral Side ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Collateral Flow ◽  
Patients At Risk

Introduction: Pencil Beam type presaturation (BeamSAT) pulse on a major cervical vessel enables selective suppression of blood flow signal of the applied vessel in MR angiography (MRA). By subtracting the BeamSAT pulse-added MRA of an internal carotid artery (ICA) from conventional MRA, only the contralateral ICA image (SubBeamSAT image) can be obtained (Figure A, B). In this way, an ICA-selective MRA with more physiologial flow pattern can be obtained, because it requires no powerful injection of contrast medium. Purpose: The aim of this study was to investigate whether preoperative assessment of the flow of Acom/A1 by SubBeamSAT image and posterior communicating artery (Pcom) by conventional MRA could identify patients at risk for intolerance to intraoperative temporary ICA occlusion. Method: 29 patients who underwent carotid endarterectomy (CEA) (n = 17) or carotid artery stenting (CAS) (n = 12) were enrolled in the current study. All patients underwent the SubBeamSAT images and conventional MRA pre- and post-operatively. Response to ICA temporally occlusion was recorded during the revascularization procedure. Results: Among twenty-nine patients, 4 patients who demonstrate neither the Acom/A1 flow on SubBeamSAT image (Figure. B) nor Pcom flow on MRA showed intolerance. In contrast, the remaining 25 patients who demonstrated Acom/A1 (Figure. A) and/or Pcom flow showed tolerance. Intolerance to ICA occlusion was excellently predicted by visualization of collateral flow via Acom and Pcom (specificity: 100%, sensitivity: 100%, p=0.00004). Conclusions: SubBeamSAT image is useful for evaluating the flow of Acom from A1 portion of the healthy side to A2 portion of the contralateral side, which is often difficult to evaluate with conventional MRA. With the SubBeamSAT image, it is feasible to evaluate the Acom/A1 flow accurately. In conclusion, SubBeamSAT image enables excellent prediction for the intolerance to temporary ICA occlusion.

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