Failure of collateral blood flow is associated with infarct growth in ischemic stroke

J Cereb Blood Flow Metab. 2013 Aug;33(8):1168-72. doi: 10.1038/jcbfm.2013.77. Epub 2013 May 8.


Changes in collateral blood flow, which sustains brain viability distal to arterial occlusion, may impact infarct evolution but have not previously been demonstrated in humans. We correlated leptomeningeal collateral flow, assessed using novel perfusion magnetic resonance imaging (MRI) processing at baseline and 3 to 5 days, with simultaneous assessment of perfusion parameters. Perfusion raw data were averaged across three consecutive slices to increase leptomeningeal collateral vessel continuity after subtraction of baseline signal analogous to digital subtraction angiography. Changes in collateral quality, Tmax hypoperfusion severity, and infarct growth were assessed between baseline and days 3 to 5 perfusion-diffusion MRI. Acute MRI was analysed for 88 patients imaged 3 to 6 hours after ischemic stroke onset. Better collateral flow at baseline was associated with larger perfusion-diffusion mismatch (Spearman's Rho 0.51, P<0.001) and smaller baseline diffusion lesion volume (Rho -0.70, P<0.001). In 30 patients without reperfusion at day 3 to 5, deterioration in collateral quality between baseline and subacute imaging was strongly associated with absolute (P=0.02) and relative (P<0.001) infarct growth. The deterioration in collateral grade correlated with increased mean Tmax hypoperfusion severity (Rho -0.68, P<0.001). Deterioration in Tmax hypoperfusion severity was also significantly associated with absolute (P=0.003) and relative (P=0.002) infarct growth. Collateral flow is dynamic and failure is associated with infarct growth.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Brain Ischemia / drug therapy
  • Brain Ischemia / pathology*
  • Brain Ischemia / physiopathology
  • Cerebral Infarction / drug therapy
  • Cerebral Infarction / pathology*
  • Cerebral Infarction / physiopathology
  • Collateral Circulation / physiology*
  • Diffusion Magnetic Resonance Imaging
  • Double-Blind Method
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Image Processing, Computer-Assisted
  • Magnetic Resonance Angiography
  • Magnetic Resonance Imaging
  • Male
  • Prospective Studies
  • Stroke / drug therapy
  • Stroke / pathology*
  • Stroke / physiopathology
  • Thrombolytic Therapy
  • Tissue Plasminogen Activator / therapeutic use


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator