Department of Neurology, University of Miami Miller School of Medicine, Clinical Research Center, Room 1331, 1120 NW 14th Street, Miami, FL 33136, USA.
Neuropharmacology. 2018 May 15;134(Pt B):280-292. doi: 10.1016/j.neuropharm.2017.08.003. Epub 2017 Aug 9.
The brain's collateral circulation consists of arterial anastomotic channels capable of providing nutrient perfusion to brain regions whose normal sources of flow have become compromised, as occurs in acute ischemic stroke. Modern CT-based neuroimaging is capable of providing detailed information as to collateral extent and sufficiency and is complemented by magnetic resonance-based methods. In the present era of standard-of-care IV thrombolysis for acute ischemic stroke, and following the recent therapeutic successes of randomized clinical trials of acute endovascular intervention, the sufficiency of the collateral circulation has been convincingly established as a key factor influencing the likelihood of successful reperfusion and favorable clinical outcome. This article reviews the features of the brain's collateral circulation; methods for its evaluation in the acute clinical setting; the relevance of collateral circulation to prognosis in acute ischemic stroke; the specific insights into the collateral circulation learned from recent trials of endovascular intervention; and the major influence of genetic factors. Finally, we emphasize the need to develop therapeutic approaches to augment collateral perfusion as an adjunctive strategy to be employed along with, or prior to, thrombolysis and endovascular interventions, and we highlight the possible potential of inhaled nitric oxide, albumin, and other approaches. This article is part of the Special Issue entitled 'Cerebral Ischemia'.
大脑的侧支循环由动脉吻合通道组成，能够为血流正常来源受损的脑区提供营养灌注，这种情况发生在急性缺血性卒中时。基于现代 CT 的神经影像学能够提供有关侧支循环程度和充分性的详细信息，并辅以基于磁共振的方法。在急性缺血性卒中标准治疗的 IV 溶栓时代，以及急性血管内介入治疗的随机临床试验最近取得治疗成功后，侧支循环的充分性已被令人信服地确立为影响成功再灌注和良好临床结局的关键因素。本文综述了大脑侧支循环的特点；在急性临床环境中评估其的方法；侧支循环与急性缺血性卒中预后的相关性；从最近的血管内介入治疗试验中获得的关于侧支循环的具体见解；以及遗传因素的主要影响。最后，我们强调需要开发增强侧支灌注的治疗方法，作为与溶栓和血管内介入治疗联合使用或之前使用的辅助策略，并强调吸入一氧化氮、白蛋白和其他方法的可能潜力。本文是特刊“脑缺血”的一部分。
