title: Hypertrophy of the vasa vasorum: vascular response to the hungry brain.
abstract: BACKGROUND
  The vasa vasorum is a network of microvessels that supplies nutrients to the vessel wall itself. In pathologic conditions, the vasa vasorum can develop as potential collateral channels. Previous research documents revascularization through hypertrophy of the vasa vasorum after occlusion of the carotid artery. However, the relationship between the cerebral vascular demands and the hypertrophy of the vasa vasorum has not been well delineated by functional studies.
  
  
  METHODS
  A 66-year-old man presented with left hemiparesis, dysarthria, and hemineglect. Magnetic resonance imaging revealed an acute infarction in the vascular territory of the right middle cerebral artery. Transfemoral cerebral angiography revealed occlusion of the right proximal internal carotid artery (ICA). Single-photon emission computed tomography study showed decreased vascular reserve in the right cerebral hemisphere. Right superficial temporal artery-middle cerebral artery bypass surgery was performed in an attempt to improve hemispheric perfusion. Follow-up angiography 1 year later showed revascularization of the distal ICA by the hypertrophied vasa vasorum. Follow-up single-photon emission computed tomography study showed persistent decreased vascular reserve.
  
  
  CONCLUSIONS
  In cases of ICA occlusion, a 1-year or less hungry period for the cerebral vascular demand may activate potential collateral channels of the vasa vasorum. In addition to the metabolic demand of the occluded vessel wall itself, the vascular demands of the hypoperfused brain may be a trigger factor that leads to hypertrophy of the vasa vasorum as collateral channels.
authors.affiliation: Department of Neurology, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hyun-Ji
authors.initials: HJ
authors.lastname: Cho
authors.forename: Hong Gee
authors.initials: HG
authors.lastname: Roh
authors.forename: Young Il
authors.initials: YI
authors.lastname: Chun
authors.forename: Chang Taek
authors.initials: CT
authors.lastname: Moon
authors.forename: Hyun Woo
authors.initials: HW
authors.lastname: Chung
authors.forename: Hahn Young
authors.initials: HY
authors.lastname: Kim
mesh_terms: D000368:Aged; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D002533:Cerebral Angiography; D006801:Humans; D006984:Hypertrophy; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D015899:Tomography, Emission-Computed, Single-Photon; D014651:Vasa Vasorum / Q000473:pathology*; D014656:Vascular Surgical Procedures / Q000379:methods*