{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:52:54Z","timestamp":1791287574907,"version":"4.1.0"},"reference-count":120,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"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:p>Secondary brain injury after traumatic brain injury (TBI) has traditionally been understood and managed through the lens of intracranial pressure, cerebral perfusion pressure, and global cerebral blood flow. Yet a substantial proportion of patients continue to exhibit persistent tissue hypoxia and metabolic crisis even when these macrocirculatory parameters appear adequately controlled. Capillary stalling\u2014the transient or sustained interruption of red blood cell transit within individual or focal capillary networks\u2014may represent an under-recognized microcirculatory disorder that conventional macrovascular monitoring cannot capture. This review synthesizes evidence supporting capillary stalling as a potentially distinct and reversible component of post-traumatic microvascular failure. We examine candidate mechanisms of capillary flow interruption after TBI, including endothelial injury and glycocalyx disruption, leukocyte plugging, pericyte contraction, platelet activation and microthrombosis, red blood cell dysfunction, and edema-associated extravascular compression. These mechanisms can generate marked capillary flow heterogeneity, impair oxygen extraction, and contribute to metabolic crisis, neuroinflammation, and secondary neuronal injury. We further discuss why conventional bedside monitoring\u2014including intracranial pressure, cerebral perfusion pressure, global cerebral blood flow, brain tissue oxygenation, and microdialysis\u2014may fail to detect capillary-level flow abnormalities, and we review established and emerging detection strategies from experimental two-photon microscopy to clinical surrogates. Finally, we evaluate potential microcirculation-targeted therapeutic avenues. Direct evidence of capillary stalling in human TBI remains limited; accordingly, it should currently be viewed as a biologically plausible and testable contributor to secondary brain injury rather than an established dominant driver.<\/jats:p>","DOI":"10.3389\/fneur.2026.1971528","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:12:11Z","timestamp":1791285131000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Capillary stalling after traumatic brain injury: an emerging microcirculatory contributor to secondary brain injury"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiaolong","family":"Lei","sequence":"first","affiliation":[{"name":"Department of Clinical Medicine, North Sichuan Medical College","place":["Nanchong, Sichuan, China"]},{"name":"Department of Emergency Medicine, The General Hospital of Western Theater Command","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The General Hospital of Western Theater Command","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaokun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The General Hospital of Western Theater Command","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, North Sichuan Medical College","place":["Nanchong, Sichuan, China"]},{"name":"Department of Emergency Medicine, The General Hospital of Western Theater Command","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.3171\/2017.10.JNS17352","article-title":"Estimating the global incidence of traumatic brain injury","volume":"130","author":"Dewan","year":"2019","journal-title":"J Neurosurg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/S1474-4422(18)30415-0","article-title":"Global, regional, and national burden of TBI and SCI, 1990-2016","volume":"18","year":"2019","journal-title":"Lancet Neurol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1016\/S1474-4422(17)30371-X","article-title":"Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research","volume":"16","author":"Maas","year":"2017","journal-title":"Lancet 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of severe TBI, 4th edition","volume":"80","author":"Carney","year":"2017","journal-title":"Neurosurgery"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1783","DOI":"10.1007\/s00134-019-05805-9","article-title":"A management algorithm for patients with ICP monitoring: SIBICC","volume":"45","author":"Hawryluk","year":"2019","journal-title":"Intensive Care Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1097\/00003246-200204000-00002","article-title":"Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal CPP in TBI","volume":"30","author":"Steiner","year":"2002","journal-title":"Crit Care Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1227\/NEU.0b013e3182287ca7","article-title":"Brain hypoxia is associated with short-term outcome after severe TBI independently of intracranial hypertension and low 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hypoxia","volume":"27","author":"Korte","year":"2024","journal-title":"Nat Neurosci"},{"key":"ref14","first-page":"437","article-title":"Cerebral ischemia. II. The no-reflow phenomenon","volume":"52","author":"Ames","year":"1968","journal-title":"Am J Pathol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1038\/jcbfm.2011.153","article-title":"The roles of cerebral blood flow, capillary transit time heterogeneity, and oxygen tension in brain oxygenation and metabolism","volume":"32","author":"Jespersen","year":"2012","journal-title":"J Cereb Blood Flow Metab"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1585","DOI":"10.1038\/jcbfm.2014.131","article-title":"Capillary transit time heterogeneity and flow-metabolism coupling after traumatic brain injury","volume":"34","author":"\u00d8stergaard","year":"2014","journal-title":"J Cereb Blood Flow Metab"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2082","DOI":"10.1038\/s42255-024-01159-9","article-title":"A pathogenic role for IL-10 signalling in capillary stalling and cognitive impairment in type 1 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Neurol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.3171\/jns.2002.97.6.1373","article-title":"Intravascular coagulation: a major secondary insult in nonfatal TBI","volume":"97","author":"Stein","year":"2002","journal-title":"J Neurosurg"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.thromres.2020.10.041","article-title":"Links between thrombosis and inflammation in TBI","volume":"198","author":"Hubbard","year":"2021","journal-title":"Thromb Res"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1177\/0271678X251353141","article-title":"Capillaries susceptible to frequent stall dynamics revealed by comparing OCT and bessel-2PM measurements","volume":"45","author":"Tang","year":"2025","journal-title":"J Cereb Blood Flow Metab"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e12845","DOI":"10.1111\/micc.12845","article-title":"Impact of stalling events on microcirculatory hemodynamics in the aged brain","volume":"31","author":"Jamshidi","year":"2024","journal-title":"Microcirculation"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1038\/nmeth.1490","article-title":"Two-photon high-resolution measurement of partial pressure of oxygen in cerebral vasculature and tissue","volume":"7","author":"Sakadzi\u0107","year":"2010","journal-title":"Nat Methods"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1276","DOI":"10.1161\/01.STR.22.10.1276","article-title":"Polymorphonuclear leukocytes occlude capillaries following middle cerebral artery occlusion and reperfusion in baboons","volume":"22","author":"del Zoppo","year":"1991","journal-title":"Stroke"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1161\/01.STR.23.5.712","article-title":"Inhibition of polymorphonuclear leukocyte adherence suppresses no-reflow after focal cerebral ischemia in 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Dis"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"210","DOI":"10.3389\/fnins.2020.00210","article-title":"In vivo two-photon imaging reveals acute cerebral vascular spasm and microthrombosis after mild TBI in mice","volume":"14","author":"Han","year":"2020","journal-title":"Front Neurosci"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"360","DOI":"10.3171\/jns.1992.77.3.0360","article-title":"Ultra-early evaluation of regional cerebral blood flow in severely head-injured patients using xenon-enhanced CT","volume":"77","author":"Bouma","year":"1992","journal-title":"J Neurosurg"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1093\/brain\/awq353","article-title":"Cerebral extracellular chemistry and outcome following TBI: a microdialysis study of 223 patients","volume":"134","author":"Timofeev","year":"2011","journal-title":"Brain"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1016\/j.jamcollsurg.2017.05.012","article-title":"Syndecan-1: a quantitative marker for the endotheliopathy of trauma","volume":"225","author":"Rodriguez","year":"2017","journal-title":"J Am Coll Surg"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1182\/blood.2020007364","article-title":"Conformation-dependent blockage of activated VWF improves outcomes of TBI","volume":"137","author":"Xu","year":"2021","journal-title":"Blood"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"1331","DOI":"10.1089\/neu.2006.0159","article-title":"Plasma von willebrand factor levels correlate with clinical outcome of severe TBI","volume":"24","author":"De Oliveira","year":"2007","journal-title":"J Neurotrauma"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1038\/nrneurol.2017.13","article-title":"The far-reaching scope of neuroinflammation after TBI","volume":"13","author":"Simon","year":"2017","journal-title":"Nat Rev Neurol"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1001\/jamaneurol.2014.3558","article-title":"Inflammation and neuroprotection in TBI","volume":"72","author":"Corps","year":"2015","journal-title":"JAMA Neurol"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/1742-2094-9-17","article-title":"Neutrophil depletion reduces edema formation and tissue loss following TBI in mice","volume":"9","author":"Kenne","year":"2012","journal-title":"J Neuroinflammation"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1177\/0271678X15610340","article-title":"What is a pericyte?","volume":"36","author":"Attwell","year":"2016","journal-title":"J Cereb Blood Flow Metab"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1007\/s12028-010-9413-7","article-title":"Juguloarterial endothelin-1 gradients after severe traumatic brain injury","volume":"14","author":"Chatfield","year":"2011","journal-title":"Neurocrit Care"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"2251","DOI":"10.1161\/01.STR.0000181077.84981.11","article-title":"Inhibition of rho kinase (ROCK) leads to increased cerebral blood flow and stroke protection","volume":"36","author":"Rikitake","year":"2005","journal-title":"Stroke"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"14535","DOI":"10.1038\/s41598-024-64940-6","article-title":"Assessment of cerebrovascular alterations induced by inflammatory response and oxidative-nitrative stress after traumatic intracranial hypertension","volume":"14","author":"Zhang","year":"2024","journal-title":"Sci Rep"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.neuron.2015.06.001","article-title":"Regional blood flow in the normal and ischemic brain is controlled by arteriolar smooth muscle cell contractility and not by capillary pericytes","volume":"87","author":"Hill","year":"2015","journal-title":"Neuron"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1038\/nri3345","article-title":"Thrombosis as an intravascular effector of innate immunity","volume":"13","author":"Engelmann","year":"2013","journal-title":"Nat Rev Immunol"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"eaax8847","DOI":"10.1126\/sciadv.aax8847","article-title":"Neutrophil extracellular traps exacerbate neurological deficits after TBI","volume":"6","author":"Vaibhav","year":"2020","journal-title":"Sci Adv"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1002\/ana.24993","article-title":"Neutrophil extracellular traps in ischemic stroke thrombi","volume":"82","author":"Laridan","year":"2017","journal-title":"Ann Neurol"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1007\/s12975-022-01074-9","article-title":"The role of neutrophil extracellular traps in early microthrombosis and brain injury after subarachnoid hemorrhage in mice","volume":"14","author":"Hao","year":"2023","journal-title":"Transl Stroke Res"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3233\/CH-2010-1328","article-title":"Effects of pravastatin on cellular ultrastructure and hemorheology in rats after TBI","volume":"46","author":"Hazer","year":"2010","journal-title":"Clin Hemorheol Microcirc"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"e1052","DOI":"10.1097\/CCE.0000000000001052","article-title":"Cell-free hemoglobin in the pathophysiology of trauma: a scoping review","volume":"6","author":"Ross","year":"2024","journal-title":"Crit Care Explor"},{"key":"ref70","doi-asserted-by":"publisher","first-page":"1383","DOI":"10.1152\/japplphysiol.01173.2011","article-title":"Low micromolar intravascular cell-free hemoglobin concentration affects vascular NO bioavailability","volume":"112","author":"Deonikar","year":"2012","journal-title":"J Appl Physiol"},{"key":"ref71","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1002\/jnr.23300","article-title":"Blood-brain barrier and traumatic brain injury","volume":"92","author":"Alves","year":"2014","journal-title":"J Neurosci Res"},{"key":"ref72","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1007\/s11064-014-1374-3","article-title":"Mechanisms of astrocyte-mediated cerebral edema","volume":"40","author":"Stokum","year":"2015","journal-title":"Neurochem Res"},{"key":"ref73","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1007\/978-3-7091-9334-1_114","article-title":"Traumatic brain edema: an overview","volume":"60","author":"Marmarou","year":"1994","journal-title":"Acta Neurochir Suppl (Wien)"},{"key":"ref74","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1038\/72256","article-title":"Aquaporin-4 deletion in mice reduces brain edema after acute water intoxication and focal cerebral ischemia","volume":"6","author":"Manley","year":"2000","journal-title":"Nat Med"},{"key":"ref75","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1097\/00004647-199701000-00009","article-title":"A model for the coupling between cerebral blood flow and oxygen metabolism during neural stimulation","volume":"17","author":"Buxton","year":"1997","journal-title":"J Cereb Blood Flow Metab"},{"key":"ref76","doi-asserted-by":"publisher","first-page":"1517","DOI":"10.1007\/s00134-015-3930-y","article-title":"Consensus statement from the 2014 international microdialysis forum","volume":"41","author":"Hutchinson","year":"2015","journal-title":"Intensive Care 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