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Stroke and Transient Ischemic Attacks of the Brain and Eye
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Other areas within the perfusion lesion also may progress to infarction, depending on the severity of the reduction in blood flow, the duration of tissue ischemia, and the capacity of the collateral circulation (e.g. pial collaterals). A good collateral circulation is associated with smaller core infarcts and improved clinical outcomes.
The Cardiovascular System and its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Myocardial infarction(MI) produces pain that is similar to angina pectoris, but the pain is usually much more severe. An infarction results from a thrombus (blood clot) or embolus (clot or other plug) blocking an artery sufficiently to produce necrosis. An MI results if the occlusion is in a coronary artery, thus affecting the myocardium. The extent of necrosis and the patient's prognosis depend largely on which artery is involved, the extent of occlusion, and the presence of collateral circulation. In a large transmural infarct (full thickness—transmural literally means "through the wall"), a large area of myocardium may necrose; if 40% or more of the left ventricular mass is infarcted, the heart is usually unable to pump effectively, and the patient will die of cardiogenic shock.
The cardiovascular system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
As major arteries narrow and block, other smaller arteries running in parallel with them tend to dilate, forming what may be regarded as a ‘natural bypass’ and to some degree mitigating the effect of the major vessel disease. This is known as the development of a collateral circulation. If arteries block suddenly, there is no time for a collateral circulation to develop, and the consequences are correspondingly more severe. Acute arterial blockage, whether due to atherosclerotic disease, embolism or trauma, therefore carries a much greater risk of limb loss than chronic stenosis or occlusion.
Dynamic observation on collateral circulation construction of patient with vertebral artery restenosis after stenting: case report
Published in International Journal of Neuroscience, 2021
Yan-Wei Yin, Qian-Qian Sun, Da-Wei Chen, Fa-Guo Zhao, Jin Shi
An extensive collateral circulation plays important role in preserving blood supply to the brain in the event of failure of the primary blood supplying system [4]. Due to sufficient blood supply through collateral circulation, almost 60% of patients tolerate even complete vascular occlusion without infarct development [13, 14]. However, it should be noted that the extent of collateral circulation is highly variable between individuals, which can interpret the variable consequence [15, 16]. For this patient, although there was restenosis at the left vertebral artery after stenting, we speculated this patient was unlikely to develop a severe stroke due to the new collateral flow which fed by external carotid collateral branches and thyrocervical trunk. Moreover, the frequency of loss of consciousness gradually decreased as the collateral circulation improvement.
Matrix metallopeptidase 9 and placental growth factor may correlate with collateral status based on whole-brain perfusion combined with multiphase computed tomography angiography
Published in Neurological Research, 2021
Bo Yang, Yarong Ding, Xin Liu, Yuan Cai, Xinxuan Yang, Qixuan Lu, Weibin Gu, Liping Liu, Yuehua Pu
Identifying the related factors and biomarkers of collateral circulation is the prerequisite to find treatment targets for improving collateral circulation. Differences of collateral assessment tools in studies may affect the consistency of the results on influence factors. Metabolic syndrome, hyperuricemia and older age [8] are associated with poor leptomeningeal collateral status in patients with acute ischemic stroke [9]. Younger age, dyslipidemia and lower creatinine levels were predictors of better collaterals in acute ischemic stroke patients from proximal MCA occlusions [10]. Several serum biomarkers have proved to be correlated with coronary collateral circulation in patients with coronary artery disease. Neuregulin-1 [11], endostatin [12], YKL-40 [13] may be useful biomarkers for coronary collateral development and potential target for therapeutic angiogenesis in patients with coronary artery disease.
Clinical considerations and assessment of risk factors when choosing endovascular thrombectomy for acute stroke
Published in Expert Review of Cardiovascular Therapy, 2020
Ankur Wadhwa, Raed Joundi, Bijoy Menon
Collaterals might be considered as a set of accessory vascular channels necessary for maintaining cerebral perfusion at the time of acute ischemia in an area of brain parenchyma due to its parent vessel occlusion [36]. Recruitment and persistence of collaterals might be dependent on several factors such as the chronicity of vessel occlusion, hemodynamic state, and various metabolic and autonomic responses at the time of acute ischemia [37]. Various scores have been developed to assess and grade the collateral circulation. A commonly used score for grading the pial collaterals involves comparing the arterial filling on the symptomatic side with the asymptomatic side [35]; see Table 1. The ESCAPE and the ESCAPE NA-1 trials used mCTA for endovascular patient selection in patients with LVO [22,38].