Occult blood flow patterns distal to an occluded artery in acute ischemic stroke

J Cereb Blood Flow Metab. 2022 Feb;42(2):292-302. doi: 10.1177/0271678X211044941. Epub 2021 Sep 22.


Residual blood flow distal to an arterial occlusion in patients with acute ischemic stroke (AIS) is associated with favorable patient outcome. Both collateral flow and thrombus permeability may contribute to such residual flow. We propose a method for discriminating between these two mechanisms, based on determining the direction of flow in multiple branches distal to the occluding thrombus using dynamic Computed Tomography Angiography (dynamic CTA). We analyzed dynamic CTA data of 30 AIS patients and present patient-specific cases that identify typical blood flow patterns and velocities. We distinguished patterns with anterograde (N = 10), retrograde (N = 9), and both flow directions (N = 11), with a large variability in velocities for each flow pattern. The observed flow patterns reflect the interplay between permeability and collaterals. The presented method characterizes distal flow and provides a tool to study patient-specific distal tissue perfusion.

Keywords: Acute ischemic stroke; blood flow quantification; collateral circulation; dynamic CTA; thrombus permeability.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Blood Flow Velocity
  • Cerebral Angiography*
  • Cerebral Arteries* / diagnostic imaging
  • Cerebral Arteries* / physiopathology
  • Collateral Circulation*
  • Computed Tomography Angiography*
  • Humans
  • Ischemic Stroke* / diagnostic imaging
  • Ischemic Stroke* / physiopathology
  • Male
  • Middle Aged