title: Assessment of arterial collateralization and its relevance to intra-arterial therapy for acute ischemic stroke.
abstract: Evidence from recent randomized controlled studies comparing intra-arterial (IA) therapy with intravenous tissue plasminogen activator highlighted the mismatch between recanalization success and clinical outcomes in patients presenting with acute ischemic stroke. There is emerging interest in the impact of arterial collateralization, as determined by leptomeningeal anastomoses (LMAs), on the treatment outcomes of IA therapy. The system of LMA constitutes the secondary network of cerebral collateral circulation apart from the Circle of Willis. Both anatomic and angiographic studies confirmed significant interindividual variability in LMA. This review aims to outline the current understanding of arterial collateralization and its impact on outcomes after IA therapy for acute ischemic stroke, underpinning the possible role of arterial collateralization assessment as a selection tool for patients most likely to benefit from IA therapy.
authors.affiliation: Department of Neurology, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia; Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Siva Seeta
authors.initials: SS
authors.lastname: Ramaiah
authors.affiliation: Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Mitchell
authors.affiliation: Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Dowling
authors.affiliation: Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, Australia; Neurointervention Service, Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia. Electronic address: bernard.yan@mh.org.au.
authors.forename: Bernard
authors.initials: B
authors.lastname: Yan
mesh_terms: D000818:Animals; D002545:Brain Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D003097:Collateral Circulation; D057510:Endovascular Procedures / Q000009:adverse effects; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007261:Infusions, Intra-Arterial; D018579:Patient Selection; D011237:Predictive Value of Tests; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Leptomeningeal anastomoses; acute ischemic stroke; intra-arterial therapy; mismatch