Article Commentary: “Hyperintense Vessels, Collateralization, and Functional Outcome in Patients With Stroke Receiving Endovascular Treatment”
Kat Dakay, DO
Nave AH, Kufner A, Bücke P, Siebert E, Kliesch S, Grittner U, et al. Hyperintense Vessels, Collateralization, and Functional Outcome in Patients With Stroke Receiving Endovascular Treatment. Stroke. 2018
The importance of collateral vessels in maintaining the penumbra during acute ischemic stroke is well-known, but how do we best measure them?
Robust collateral vessels are associated with better perfusion of the ischemic penumbra and a better outcome after endovascular therapy in large vessel occlusion as compared to poor collateral vessels (Bang, Saver et al. 2011). Patients with poor collaterals may be at a higher risk for hemorrhagic transformation following recanalization (Bang, Saver et al. 2011). In some cases, collateral vessels may influence the decision whether or not to intervene on a large vessel occlusion.
Cerebral angiography offers a detailed, dynamic view of the cerebral collaterals but is an invasive procedure, often occurring after the decision to intervene is already made. CT angiography is probably the most widely used method of measuring collateral vessels and can occur in conjunction with the non-contrast CT performed during an acute stroke activation.