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

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.

Download Full-text

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

Stroke ◽

10.1161/str.46.suppl_1.tp88 ◽

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.

Download Full-text

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

World Neurosurgery ◽

10.1016/j.wneu.2018.02.189 ◽

2018 ◽

Vol 114 ◽

pp. 421-426.e1 ◽

Cited By ~ 2

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

Download Full-text

A Longitudinal Study of Collateral Flow Patterns in the Circle of Willis and the Ophthalmic Artery in Patients With a Symptomatic Internal Carotid Artery Occlusion

Stroke ◽

10.1161/01.str.31.8.1913 ◽

2000 ◽

Vol 31 (8) ◽

pp. 1913-1920 ◽

Cited By ~ 53

Author(s):

D. R. Rutgers ◽

C. J. M. Klijn ◽

L. J. Kappelle ◽

A. C. van Huffelen ◽

J. van der Grond

Keyword(s):

Longitudinal Study ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Ophthalmic Artery ◽

Internal Carotid ◽

Flow Patterns ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Circle Of Willis ◽

Collateral Flow

Download Full-text

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

Stroke ◽

10.1161/str.48.suppl_1.wp33 ◽

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’.

Download Full-text

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

Stroke ◽

10.1161/str.48.suppl_1.wp150 ◽

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.

Download Full-text

Abstract TMP108: Stroke Prediction for Patient Undergoing Carotid Artery Occlusion for Carotid Blowout Syndrome Using Computed Tomography Angiography of the Circle of Willis

Stroke ◽

10.1161/str.49.suppl_1.tmp108 ◽

2018 ◽

Vol 49 (Suppl_1) ◽

Author(s):

Bo-Ching Lee ◽

Yen-Heng Lin ◽

Chung-Wei Lee

Keyword(s):

Computed Tomography ◽

Carotid Artery ◽

Computed Tomography Angiography ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Circle Of Willis ◽

Carotid Blowout Syndrome

Download Full-text

Progression of carotid artery disease could stratify a risk of coronary artery disease patients with type 2 diabetes

Acta Biochimica et Biophysica Sinica ◽

10.1093/abbs/gmy149 ◽

2018 ◽

Vol 51 (1) ◽

pp. 120-122 ◽

Cited By ~ 2

Author(s):

Marijan Bosevski ◽

Pece Nikolovski ◽

Lily Stojanovska ◽

Vasso Apostolopoulos

Keyword(s):

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Carotid Artery ◽

Carotid Artery Disease ◽

Artery Disease

Download Full-text

Anterior communicating artery collateral flow protection against ischemic change during carotid endarterectomy

Journal of Neurosurgery ◽

10.3171/jns.1993.79.3.0379 ◽

1993 ◽

Vol 79 (3) ◽

pp. 379-382 ◽

Cited By ~ 34

Author(s):

Maria V. Lopez-Bresnahan ◽

Lee A. Kearse ◽

Paulino Yanez ◽

Tina I. Young

Keyword(s):

Cerebral Ischemia ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Cerebral Arteries ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Anterior Communicating Artery ◽

Collateral Flow ◽

Content Type ◽

Carotid Circulation

✓ The purpose of this study was to determine whether preoperative angiographic patterns of collateral cerebral blood flow correlate with protection against intraoperative electroencephalographic (EEG) evidence of cerebral ischemia caused by carotid artery cross-clamping during carotid endarterectomy. Previous studies have shown that contralateral carotid artery occlusion and intracranial stenoses are associated with cerebral ischemia during carotid endarterectomy; however, the angiographic collateral flow patterns associated with cerebral ischemia have not been identified. This paper reports a retrospective study of 67 patients who underwent two- to four-vessel cerebral angiography followed by carotid endarterectomy with 16-channel EEG monitoring. The angiograms were reviewed for extracranial occlusive disease and collateral flow patterns, and the EEG recordings were analyzed for ischemic changes during carotid artery cross-clamping. Statistical analysis was by Fisher's exact test. Cross-filling of the anterior and middle cerebral arteries from the contralateral carotid artery through the anterior communicating artery correlated with a decreased incidence of EEG ischemic changes. Only 21% of patients with this collateral flow pattern showed ischemic changes compared to 50% of patients without this pattern (p < 0.03). Three angiographic findings occurring in combination on the side contralateral to surgery correlated with EEG ischemia: 1) occlusion of the contralateral internal carotid artery (five of seven or 71%, p < 0.03); 2) collateral flow from the external carotid circulation to the internal carotid circulation via the ophthalmic artery; and 3) collateral flow from the posterior circulation to the contralateral anterior circulation via the posterior communicating artery. The data presented here corroborate the correlation between contralateral carotid artery occlusion and cerebral ischemia during carotid endarterectomy. They also demonstrate that cross-filling of the anterior and middle cerebral arteries by the contralateral carotid artery protects against such ischemia. This collateral flow may serve as an indicator of tolerance to carotid artery cross-clamping.

Download Full-text