Role of collateral flow on cerebral hemodynamics in patients with unilateral internal carotid artery occlusion

Ann Neurol. 1998 Aug;44(2):167-76. doi: 10.1002/ana.410440206.


The objective of this study was to evaluate the role of collateral blood flow via the anterior and posterior communicating arteries (ACoA and PCoA) and via the ophthalmic artery (OphA) on cerebral hemodynamics, metabolism, and border zone infarcts in 57 patients with unilateral symptomatic occlusions of the internal carotid artery. Collateral flow via the ACoA and PCoA was determined with magnetic resonance angiography (MRA) and collateral flow via the OphA with transcranial Doppler (TCD). Volume flow was studied with MRA, metabolism with 1H MR spectroscopy, CO2 reactivity with TCD, and the incidence of border zone infarcts with MRI. Compared with controls, patients had deteriorated volume flow, metabolism, and CO2 reactivity. No differences were found between patients with and patients without collateral flow through the ACoA and/or PCoA, or between patients with or without collateral flow via the OphA. Patients without collateral flow via any of these collaterals had decreased volume flow in the middle cerebral artery, decreased N-acetylaspartate/choline, and increased lactate/N-acetylaspartate, compared with the other patients. Patients with symptomatic internal carotid artery occlusion have deteriorated cerebral hemodynamics and metabolism. Different collateral flow patterns via the ACoA, PCoA, or OphA have no effect on the hemodynamic and metabolic parameters, as long as one of these pathways is present.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arterial Occlusive Diseases / complications
  • Arterial Occlusive Diseases / diagnosis
  • Arterial Occlusive Diseases / physiopathology*
  • Basilar Artery / diagnostic imaging
  • Basilar Artery / pathology
  • Basilar Artery / physiopathology
  • Breath Tests
  • Carbon Dioxide / analysis
  • Carotid Artery Diseases / complications
  • Carotid Artery Diseases / diagnosis
  • Carotid Artery Diseases / physiopathology*
  • Carotid Artery, Internal / diagnostic imaging
  • Carotid Artery, Internal / pathology
  • Carotid Artery, Internal / physiopathology
  • Cerebral Angiography
  • Cerebral Arteries / diagnostic imaging
  • Cerebral Arteries / pathology
  • Cerebral Arteries / physiopathology
  • Cerebral Infarction / etiology
  • Chi-Square Distribution
  • Collateral Circulation*
  • Female
  • Hemodynamics
  • Humans
  • Magnetic Resonance Angiography
  • Magnetic Resonance Imaging
  • Magnetic Resonance Spectroscopy
  • Male
  • Middle Aged
  • Ophthalmic Artery / diagnostic imaging
  • Ophthalmic Artery / pathology
  • Ophthalmic Artery / physiopathology
  • Recurrence
  • Regional Blood Flow
  • Ultrasonography, Doppler, Transcranial


  • Carbon Dioxide