Diagnostics of collateral circulation during revascularization of cerebral arteries

Abstract

54 patients with acute stroke were examined and treated: 12 patients were treated by thrombolytic therapy and/or thrombectomy, 22 patients were treated by endarterectomy from the internal carotid artery, and 20 patients were treated by anticoagulant, nootropic and antiplatelet therapy. Collateral blood circulation of blood vessels and foci of cerebral ischemia in ischemic stroke were examined in all patients to select a treatment method. The effect of collateral circulation in patients with recanalization of the carotid and cerebral arteries on the outcome of acute stroke treatment was analyzed. According to such parameters of neuroimaging as a large nucleus and poor collaterals, 25 out of 54 patients did not respond to revascularizing therapy, which was proved by CT data and a slight regression of neurological deficit within 14 days. Patients with a large nucleus and poor collateral circulation do not respond to revascularization surgery. Compared groups of patients according to CT data. It was found that the level of development of collaterals was associated with better clinical results. Adequate collateral circulation can help maintain tissue viability in the absence of recanalization. The choice of revascularization method depends on the state of collateral circulation, the size of the ischemic focus (according to CT, MRI) and the duration of treatment from the onset of stroke. Diagnosis of ischemia should begin with MRI angiography on the first day or CT angiography from the second day, which will allow assessing the level of collaterals, giving an idea of ​​collateral perfusion in patients and the size of the lesion.