Winship Ian R
Neurochemical Research Unit, Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.
Microcirculation. 2015 Apr;22(3):228-36. doi: 10.1111/micc.12177.
Cerebral collaterals are vascular redundancies in the cerebral circulation that can partially maintain blood flow to ischemic tissue when primary conduits are blocked. After occlusion of a cerebral artery, anastomoses connecting the distal segments of the MCA with distal branches of the ACA and PCA (known as leptomeningeal or pial collaterals) allow for partially maintained blood flow in the ischemic penumbra and delay or prevent cell death. However, collateral circulation varies dramatically between individuals, and collateral extent is significant predictor of stroke severity and recanalization rate. Collateral therapeutics attempt to harness these vascular redundancies by enhancing blood flow through pial collaterals to reduce ischemia and brain damage after cerebral arterial occlusion. While therapies to enhance collateral flow remain relatively nascent neuroprotective strategies, experimental therapies including inhaled NO, transient suprarenal aortic occlusion, and electrical stimulation of the parasympathetic sphenopalatine ganglion show promise as collateral therapeutics with the potential to improve treatment of acute ischemic stroke.
脑侧支循环是脑循环中的血管冗余结构，当主要血管被阻塞时，它可以部分维持缺血组织的血流。大脑动脉闭塞后，连接大脑中动脉远端段与大脑前动脉和大脑后动脉远端分支的吻合支（称为软脑膜或软膜侧支）可使缺血半暗带的血流得到部分维持，并延缓或防止细胞死亡。然而，个体之间的侧支循环差异很大，侧支循环程度是中风严重程度和再通率的重要预测指标。侧支循环治疗旨在通过增加软脑膜侧支的血流来利用这些血管冗余结构，以减少脑动脉闭塞后的缺血和脑损伤。虽然增强侧支血流的治疗方法仍然是相对新兴的神经保护策略，但包括吸入一氧化氮、短暂性肾动脉以上主动脉闭塞以及对副交感神经蝶腭神经节进行电刺激在内的实验性治疗方法，作为有潜力改善急性缺血性中风治疗效果的侧支循环治疗方法显示出了前景。
