{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T03:23:44Z","timestamp":1774841024980,"version":"3.50.1"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T00:00:00Z","timestamp":1730073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Despite the fundamental role of pial collateral vessels in limiting the progression of ischemic tissue injury in acute stroke with large vessel occlusion (LVO), in addition to the fact that collateral vessel abundance varies naturally from person to person for genetic reasons, there is limited knowledge regarding potential factors contributing to inherent interindividual variation in pial collateral supply. As it has been repeatedly hypothesized that chronic carotid occlusive disease may favor pial collateralization, we aimed to investigate the association between quantitatively assessed leptomeningeal collateral supply and pre-existing carotid stenosis in patients with acute stroke due to LVO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Patients with proximal middle cerebral artery (MCA) occlusion with or without additional internal carotid artery (ICA) occlusion were included. The degree of collateral supply was quantitatively assessed based on signal variance in T2*-weighted time series in perfusion-weighted magnetic resonance imaging (PWI). Patients were stratified into two groups according to quantitative collateral status (poor and fair to good collateral supply). The prevalence of high-grade ICA stenosis (\u226570%) was evaluated in both groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 98 patients (mean age 68.8 \u00b1 16.1\u2009years, <jats:italic>n<\/jats:italic>\u2009=\u200952 (53.1%) of whom were female individuals) with MCA and\/or ICA occlusion were included in the final analysis. Out of these patients, 42 had poor collateral supply, while 56 exhibited fair to good collateral supply. Additionally, 18 patients showed ipsilateral high-grade ICA stenosis. After classifying the entire cohort based on their collateral status (poor vs. fair to good collateral supply), there was no significant difference in the proportion of the patients with ipsilateral high-grade ICA stenosis between the two groups. Specifically, 6 (14.3%) patients had poor collateral supply, and 12 (21.1%) patients had fair to good collateral supply. The odds ratio (OR) was 1.58, with a 95% confidence interval (CI) of 0.490\u20135.685 and the <jats:italic>p-<\/jats:italic>value of 0.440. In the entire patient cohort, signal variance-based collateral supply was significantly correlated with initial stroke severity (<jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.360, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), baseline ischemic core volume (<jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.362, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), and functional outcomes (score on the modified Rankin Scale) at discharge (<jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.367, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this study, we performed a quantitative and observer-independent MRI-based collateral assessment in patients with LVO. We found no significant difference in the prevalence of pre-existing high-grade ICA stenosis between patients with fair to good collateral supply and those with poor collateral supply. The potential influence of demographic and clinical variables on pial collateral supply in patients with acute stroke warrants further exploration in future studies. MRI-based collateral supply is significantly related to initial stroke severity, ischemic core volume, and early functional outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2024.1423967","type":"journal-article","created":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T04:45:59Z","timestamp":1730090759000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Recruitment of pial collaterals and carotid occlusive disease in large-vessel occlusion ischemic stroke"],"prefix":"10.3389","volume":"15","author":[{"given":"Niklas","family":"Helwig","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marlies","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Seiler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,10,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2279","DOI":"10.1161\/01.STR.0000086465.41263.06","article-title":"Collateral circulation","volume":"34","author":"Liebeskind","year":"2003","journal-title":"Stroke"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1161\/STROKEAHA.121.034471","article-title":"Collateral circulation in Thrombectomy for stroke after 6 to 24 hours in the DAWN trial","volume":"53","author":"Liebeskind","year":"2022","journal-title":"Stroke"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1002\/ana.23906","article-title":"Leptomeningeal collaterals are associated with modifiable metabolic risk factors","volume":"74","author":"Menon","year":"2013","journal-title":"Ann Neurol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1181001","DOI":"10.3389\/fneur.2023.1181001","article-title":"Determinants of cerebral collateral circulation in acute ischemic stroke due to large vessel occlusion","volume":"14","author":"Sperti","year":"2023","journal-title":"Front Neurol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2018","DOI":"10.1016\/j.jstrokecerebrovasdis.2014.02.018","article-title":"Demographic and clinical predictors of leptomeningeal collaterals in stroke patients","volume":"23","author":"Malik","year":"2014","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2507","DOI":"10.1161\/01.CIR.0000065118.99409.5F","article-title":"Coronary collaterals: an important and underexposed aspect of coronary artery disease","volume":"107","author":"Koerselman","year":"2003","journal-title":"Circulation"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2021","DOI":"10.1177\/0271678X17724027","article-title":"Relationship between haemodynamic impairment and collateral blood flow in carotid artery disease","volume":"38","author":"Hartkamp","year":"2018","journal-title":"J Cereb Blood Flow Metab"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e0245337","DOI":"10.1371\/journal.pone.0245337","article-title":"Middle cerebral artery pressure laterality in patients with symptomatic ICA stenosis","volume":"16","author":"Holmgren","year":"2021","journal-title":"PLoS One"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"279","DOI":"10.2174\/157340309789317887","article-title":"Cerebral collateral circulation in carotid artery disease","volume":"5","author":"Romero","year":"2009","journal-title":"Curr Cardiol Rev"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1007\/s00062-017-0568-x","article-title":"Internal carotid artery stenosis and collateral recruitment in stroke patients","volume":"28","author":"Dankbaar","year":"2018","journal-title":"Clin Neuroradiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1293","DOI":"10.1038\/jcbfm.2010.224","article-title":"Collateral circulation in symptomatic intracranial atherosclerosis","volume":"31","author":"Liebeskind","year":"2011","journal-title":"J Cereb Blood Flow Metab"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"3222","DOI":"10.1161\/STROKEAHA.121.037869","article-title":"Cerebral collateral circulation in the era of reperfusion therapies for acute ischemic stroke","volume":"53","author":"Uniken Venema","year":"2022","journal-title":"Stroke"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1177\/0271678X19898148","article-title":"DSC perfusion-based collateral imaging and quantitative T2 mapping to assess regional recruitment of leptomeningeal collaterals and microstructural cortical tissue damage in unilateral steno-occlusive vasculopathy","volume":"41","author":"Seiler","year":"2021","journal-title":"J Cereb Blood Flow Metab"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1177\/0271678X19831024","article-title":"Signal variance-based collateral index in DSC perfusion: a novel method to assess leptomeningeal collateralization in acute ischaemic stroke","volume":"40","author":"Seiler","year":"2020","journal-title":"J Cereb Blood Flow Metab"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1111\/ijs.12068","article-title":"Apparent diffusion coefficient threshold for delineation of ischemic core","volume":"10","author":"Purushotham","year":"2015","journal-title":"Int J Stroke"},{"key":"ref16","first-page":"97","article-title":"CT angiographic analysis of carotid artery stenosis: comparison of manual assessment, semiautomatic vessel analysis, and digital subtraction angiography","volume":"28","author":"Silvennoinen","year":"2007","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"574","DOI":"10.3174\/ajnr.A8180","article-title":"Association of Carotid Artery Disease with collateralization and infarct growth in patients with acute middle cerebral artery occlusion","volume":"45","author":"Guney","year":"2024","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1161\/STROKEAHA.118.023407","article-title":"Results from DEFUSE 3: good collaterals are associated with reduced ischemic Core growth but not neurologic outcome","volume":"50","author":"de Havenon","year":"2019","journal-title":"Stroke"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"3408","DOI":"10.1161\/STROKEAHA.119.026499","article-title":"Contralateral hemispheric cerebral blood flow measured with arterial spin labeling can predict outcome in acute stroke","volume":"50","author":"Thamm","year":"2019","journal-title":"Stroke"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"3039","DOI":"10.1177\/0271678X211024373","article-title":"Leptomeningeal collateral activation indicates severely impaired cerebrovascular reserve capacity in patients with symptomatic unilateral carotid artery occlusion","volume":"41","author":"Sebok","year":"2021","journal-title":"J Cereb Blood Flow Metab"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e020792","DOI":"10.1161\/JAHA.121.020792","article-title":"Mapping cerebrovascular reactivity impairment in patients with symptomatic unilateral carotid artery disease","volume":"10","author":"Sebok","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"863483","DOI":"10.3389\/fneur.2022.863483","article-title":"Association of Systolic Blood Pressure and Cerebral Collateral Flow in acute ischemic stroke by stroke subtype","volume":"13","author":"Sim","year":"2022","journal-title":"Front Neurol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1751","DOI":"10.1161\/STROKEAHA.119.025142","article-title":"Detrimental effect of chronic hypertension on leptomeningeal collateral flow in acute ischemic stroke","volume":"50","author":"Fujita","year":"2019","journal-title":"Stroke"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"3014","DOI":"10.1161\/STROKEAHA.116.014882","article-title":"Impaired collateral flow compensation during chronic cerebral Hypoperfusion in the type 2 diabetic mice","volume":"47","author":"Nishijima","year":"2016","journal-title":"Stroke"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1404","DOI":"10.1161\/STROKEAHA.119.027661","article-title":"Collateral recruitment is impaired by cerebral small vessel disease","volume":"51","author":"Lin","year":"2020","journal-title":"Stroke"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"4708","DOI":"10.1007\/s00415-022-11099-7","article-title":"Small vessel disease and collaterals in ischemic stroke patients treated with thrombectomy","volume":"269","author":"Forestier","year":"2022","journal-title":"J Neurol"},{"key":"ref27","first-page":"70","article-title":"Occurence and variability in acute formation of leptomeningeal collaterals in proximal middle cerebral artery occlusion","volume":"1","author":"Qureshi","year":"2008","journal-title":"J Vasc Interv Neurol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1007\/s00234-016-1727-5","article-title":"Dutch acute stroke study i. determinants of leptomeningeal collateral flow in stroke patients with a middle cerebral artery occlusion","volume":"58","author":"van Seeters","year":"2016","journal-title":"Neuroradiology"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e000340","DOI":"10.1136\/bmjno-2022-000340","article-title":"Circle of Willis variation and outcome after intra-arterial treatment","volume":"4","author":"Rozeman","year":"2022","journal-title":"BMJ Neurol Open"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"3682","DOI":"10.1111\/ene.15013","article-title":"Circle of Willis variants and their association with outcome in patients with middle cerebral artery-M1-occlusion stroke","volume":"28","author":"Westphal","year":"2021","journal-title":"Eur J Neurol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"110383","DOI":"10.1016\/j.ejrad.2022.110383","article-title":"Incomplete circle of Willis variants and stroke outcome","volume":"153","author":"Lin","year":"2022","journal-title":"Eur J Radiol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1136\/svn-2020-000491","article-title":"Circle of Willis variants are not associated with thrombectomy outcomes","volume":"6","author":"Seifert-Held","year":"2021","journal-title":"Stroke Vasc Neurol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s12868-021-00609-4","article-title":"Association between circle of Willis and ischemic stroke: a systematic review and meta-analysis","volume":"22","author":"Oumer","year":"2021","journal-title":"BMC Neurosci"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"E12","DOI":"10.3171\/2021.4.FOCUS21125","article-title":"Agreement of novel hemodynamic imaging parameters for the acute and chronic stages of ischemic stroke: a matched-pair cohort study","volume":"51","author":"Sebok","year":"2021","journal-title":"Neurosurg Focus"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.3171\/2021.10.JNS21986","article-title":"Flow augmentation STA-MCA bypass evaluation for patients with acute stroke and unilateral large vessel occlusion: a proposal for an urgent bypass flowchart","volume":"137","author":"Sebok","year":"2022","journal-title":"J Neurosurg"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"777","DOI":"10.21037\/qims-23-876","article-title":"Flow-augmentation STA-MCA bypass for acute and subacute ischemic stroke due to internal carotid artery occlusion and the role of advanced neuroimaging with hemodynamic and flow-measurement in the decision-making: preliminary data","volume":"14","author":"Sebok","year":"2024","journal-title":"Quant Imaging Med Surg"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1016\/S0140-6736(23)00575-5","article-title":"Endovascular treatment versus no endovascular treatment after 6-24 h in patients with ischaemic stroke and collateral flow on CT angiography (MR CLEAN-LATE) in the Netherlands: a multicentre, open-label, blinded-endpoint, randomised, controlled, phase 3 trial","volume":"401","author":"Olthuis","year":"2023","journal-title":"Lancet"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1016\/S1474-4422(24)00228-X","article-title":"Collateral-based selection for endovascular treatment of acute ischaemic stroke in the late window (MR CLEAN-LATE): 2-year follow-up of a phase 3, multicentre, open-label, randomised controlled trial in the Netherlands","volume":"23","author":"Huijberts","year":"2024","journal-title":"Lancet Neurol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1111\/jon.13220","article-title":"Pial collaterals limit stroke progression and metabolic stress in hypoperfused tissue: an MRI perfusion and mq-BOLD study","volume":"34","author":"Frank","year":"2024","journal-title":"J Neuroimaging"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1597","DOI":"10.1161\/STROKEAHA.121.036104","article-title":"Microvascular dysfunction in blood-brain barrier disruption and Hypoperfusion within the infarct posttreatment are associated with cerebral edema","volume":"53","author":"Ng","year":"2022","journal-title":"Stroke"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"e790","DOI":"10.1212\/WNL.0000000000013210","article-title":"Prevalence and significance of impaired microvascular tissue reperfusion despite macrovascular angiographic reperfusion (no-reflow)","volume":"98","author":"Ng","year":"2022","journal-title":"Neurology"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1456","DOI":"10.1016\/j.neuron.2024.01.031","article-title":"Leptomeningeal collaterals regulate reperfusion in ischemic stroke and rescue the brain from futile recanalization","volume":"112","author":"Binder","year":"2024","journal-title":"Neuron"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1423967\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T04:46:01Z","timestamp":1730090761000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1423967\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,28]]},"references-count":42,"alternative-id":["10.3389\/fneur.2024.1423967"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2024.1423967","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,28]]},"article-number":"1423967"}}