Poor Collateral Group Research Articles

Effect of Coronary Collateral Supply on Left Ventricular Global Longitudinal Strain after Recanalization of Chronic Total Occlusion.

Percutaneous coronary intervention (PCI) to chronic total occlusion (CTO) is still a subject of debate. The primary goal of revascularization is to provide symptomatic relief and enhance left ventricular (LV) functions. Global longitudinal strain (GLS) is proven to be more sensitive than the ejection fraction (EF), especially for subtle ischemic changes. The purpose of this study was to investigate the improvement in LV GLS after revascularization of symptomatic stable coronary patients with single-vessel CTO, categorized according to their collateral supply grades. Sixty-nine patients with successful CTO-PCI were grouped, according to their collateral supply grades, as well-developed (WD) and poor collateral groups and followed-up for 3 months. Basal characteristics were similar for both groups, except for a lower EF (p = 0.04) and impaired GLS (p < 0.0001) in the poor collateral group. At the end of 3 months follow-up, symptomatic relief was similar in both groups (p = 0.101). GLS improvement reached statistical significance only for the poor collateral, not for the WD group (p < 0.0001 and p = 0.054, respectively). The EF did not change significantly in both groups. Poorly collateralized CTO lesions may not only result in baseline LV dysfunction, but also appear to carry potential for recovery after revascularization. This may not be the case for WD collaterals.

Predictive value of white matter hyperintensity burden combined with collateral circulation in mechanical thrombectomy for acute anterior circulation large vessel occlusion

ObjectiveTo investigate the correlation and predictive value of white matter hyperintensity (WMH) burden in conjunction with collateral circulation during mechanical thrombectomy (MT) for acute anterior circulation occlusion. MethodsA database comprising consecutive registrations of patients who underwent mechanical thrombectomy for acute anterior circulation large vessel occlusive cerebral infarction at Nanjing Drum Tower Hospital from January 2018 to December 2021 was analyzed. Collateral circulation was assessed using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scoring criteria. The good collateral group included ASITN/SIR grades 3 and 4, while the poor collateral group included grades 1 and 2. Additionally, white matter hyperintensity burden was evaluated using white matter hyperintensity volume and the Fazekas scoring system. A favorable functional outcome was defined as a modified Rankin scale (mRS) of 0–2 at 90 days. Multivariable logistic regression analyses and Spearman correlation analysis were employed to assess the correlation between white matter hyperintensity burden and unfavorable outcomes in mechanical thrombectomy. ResultsA total of 123 patients who underwent mechanical thrombectomy for acute anterior circulation occlusion were included (56.9 % male). Favorable outcomes were observed in 45.5 % (56/123) of cases. Those with a low ASITN/SIR scale (r = -1.33, 95 % CI: 0.26 (0.09–0.78), P=0.01; cutoff value = 2.5), low low-density lipoprotein cholesterol (LDL-C) level (r = -1.00, 95 % CI: 0.37 (0.15–0.92), P=0.03; cutoff value = 2.26), and high white matter hyperintense volume (r = 0.28, 95 % CI: 1.33 (1.03–1.71), P=0.03; cutoff value = 10.03) were more likely to experience unfavorable outcomes. Moreover, when compared to ASITN/SIR scale (AUC=89.6, 95 % CI: 0.09–0.78) and LDL level (AUC=62.8, 95 % CI: 0.15–0.92), white matter hyperintense volume demonstrated greater accuracy in predicting poor outcomes (AUC=94.4, 95 % CI: 1.03–1.71). Importantly, white matter hyperintense volume showed a positive correlation with the modified Rankin Scale (mRS) Score (r = 0.8289, P<0.0001). In brief, the burden of white matter hyperintensity is negatively correlated with collateral circulation in mechanical thrombectomy for acute anterior circulation occlusion. ConclusionsThe higher the burden of white matter hyperintensity, the worse the collateral circulation in mechanical thrombectomy for acute anterior circulation occlusion. The combination of high white matter hyperintensity volume and poor collateral circulation enhances might predict a worse clinical outcome of mechanical thrombectomy with acute anterior circulation occlusion.

Importance of computed tomography perfusion on assessing collateral circulation and prognosis of patients with acute anterior circulation large vessel occlusion after endovascular therapy

This study probed the importance of computed tomography perfusion (CTP) on assessing collateral circulation and prognosis in patients with acute anterior circulation large vessel occlusion (AAC-LVO) after endovascular therapy (EVT). Retrospective analysis was performed on the case data of 124 AAC-LVO patients who achieved EVT in the First People's Hospital of Lianyungang. All patients received computed tomography (CT) examination. Based on the multi-phase computed tomography angiography (mCTA) score, patients were separated into poor collateral circulation group and good collateral circulation group. Based on modified Rankin scale (mRS) score, patients were separated into good prognosis group and poor prognosis group. The receiver operating characteristic (ROC) curve was used to measure the efficacy of CTP parameters in predicting good collateral circulation or good prognosis. Correlation between CTP parameters with mCTA collateral and 90-day mRS circulation score was analyzed using the Spearman correlation analysis. The age and admission national Institutes of Health stroke scale (NIHSS) scores of the good collateral circulation group were lower than the poor collateral circulation group, and low perfusion area volume with Tmax > 6 s (VTmax>6 s), infarct core area volume (VCBF<30 %)and hypoperfusion intensity ratio (HIR) were also lower. The mCTA collateral cycle score was negatively related to VTmax>6s, VCBF<30 % and HIR. The area under the curve (AUC) values of VTmax>6s and VCBF<30 % and HIR for predicting good collateral circulation were 0.763, 0.884 and 0.842, respectively, which suggested that perfusion parameters VTmax>6s, VCBF<30 % and HIR could effectively indicate the status of patients’ collateral circulation. Relative to the poor prognosis group, patients in the good prognosis group possessed lower admission NIHSS score, younger age, smaller final infarct volume, lower HIR, VCBF<30 %, VTmax>6 s, Alberta Stroke Program Early CT(ASPECT) score, and higher mCTA score. Spearman correlation analysis unveiled that ASPECT score, mCTA score and 90-day mRS were negatively correlated. The final infarct volume, perfusion parameters HIR and VCBF<30 % were positively correlated with 90-day mRS. ROC analysis showed that all variates had good prognostic value for acute anterior circulation great vessel occlusion patients, while VCBF<30 % and HIR had high diagnostic value for prognosis. To sum up, CTP can provide a comprehensive imaging assessment of the collateral circulation of patients with AAC-LVO and has a higher predictive value for the prognosis assessment of patients with EVT in terms of VCBF<30 %, HIR score and mCTA collateral circulation score.

Effect of collateral status on the outcomes of endovascular treatment of acute basilar artery occlusion due to large-artery atherosclerosis.

Authors of this study aimed to evaluate the effects of collateral status on the prognostic value of endovascular treatment (EVT) in patients with basilar artery occlusion (BAO) due to large-artery atherosclerosis (LAA). The study included 312 patients from the BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion Study) registry who had undergone EVT for acute BAO due to LAA and whose composite collateral scores were available. The effects of collateral status on EVT were assessed based on the composite collateral score (0-2 vs 3-5). The primary outcome was a favorable outcome (modified Rankin Scale score of 0-3) at 90 days. The composite collateral score was 0-2 in 130 patients and 3-5 in 182. A good collateral status (composite collateral score 3-5) was associated with a favorable outcome (66/182 [36.3%] vs 31/130 [23.8%], adjusted odds ratio [aOR] 2.21, 95% CI 1.18-4.14, p = 0.014). A lower baseline National Institutes of Health Stroke Scale (NIHSS) score was an independent predictor of a favorable outcome in the poor collateral status group (aOR 0.91, 95% CI 0.87-0.96, p = 0.001). In the good collateral status group, there was a significant correlation between favorable outcomes and a younger age (aOR 0.96, 95% CI 0.92-0.99, p = 0.016), lower baseline NIHSS score (aOR 0.89, 95% CI 0.85-0.93, p < 0.001), lower proportion of diabetes mellitus (aOR 0.31, 95% CI 0.13-0.75, p = 0.009), and shorter procedure time (aOR 0.99, 95% CI 0.98-1.00, p = 0.003). A good collateral status was a strong prognostic factor after EVT in patients with BAO underlying LAA. A shorter procedure time was associated with favorable outcomes in patients with a good collateral status.

A new marker of coronary collateral flow in patients presenting with acute myocardial infarction.

Multimerin-2 is an adhesion substrate between pericytes and basal membranes during angiogenesis. The present study aimed to assess the relationship between serum Multimerin-2 and coronary collateral flow grade. Between April 2022 and August 2022, 88 patients with subacute ST-elevation myocardial infarction were included in this study. The main inclusion criteria were patients who present 12-48 hours after symptom onset and aged between 18 and 90 years. The patients were divided into two groups according to the Rentrop classification: poor collateral group (Rentrop grade 0-1) and good collateral group (Rentrop grade 2-3). Biochemical and hematological parameters were measured before coronary angiography. Serum Multimerin-2 levels were found to be significantly different between the two groups, and levels were higher in the Rentrop 2-3 group than in the Rentrop 0-1 group (3,527.9 ± 1,194.2 pg/ml and 946.7 ± 249.1 pg/ml; p < 0.00). Receiver operating characteristic curve analysis indicated that the area under the curve was 0.918 (p = 0.001), and the best cut-off value of 849 pg/ml had a sensitivity of 90.1% and a specificity of 84.1% for predicting Rentrop grade 2-3 coronary flow. The number of patients with low left ventricular ejection fraction (LVEF) by echocardiography at 30 days was significantly higher in patients with poor collateralization. Multimerin-2 levels were found to be higher in patients with Rentrop grade 2-3 coronary flow than Rentrop grade 0-1 coronary flow after myocardial infarction. We detected a potential relationship between MMR-2 and good coronary collateral formation.

The effect of interarm blood pressure difference on coronary collateral flow in patients with ST-segment elevation myocardial infarction who had undergone primary percutaneous coronary intervention.

In patients with acute myocardial infarction, coronary collateral circulation (CCC) is associated with reduced infarct size, preserved cardiac function, and decreased mortality. An interarm blood pressure difference (IABPD) is shown to be independently associated with cardiovascular and all-cause of mortality. We aimed to determine the effect of IABPD on coronary collateral flow in patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary percutaneous coronary intervention (p-PCI). We prospectively investigated 1,348 consecutive patients who were hospitalized for STEMI and underwent p-PCI. The Rentrop classification was used to assess CCC. According to this classification, we defined Rentrop 0 and 1 as poor CCC, and Rentrop 2 and 3 as good CCC. A 10 mm Hg difference is considered the upper limit of IABPD. Patients were divided into two groups according to the collateral circulation, 325 patients (24%) had good collateral, while 1,023 patients (76%) had poor collateral. IABPD was significantly higher in the poor collateral group (57 patients, 5.6%) than in the good collateral group (9 patients, 2.8%) (p=0.04). Pre-infarction angina and IABPD were identified as independent predictors of poor collateral (OR: 0.516, 95% CI 0.370-0.631, p=0.007; OR: 3.681, 95% CI: 1.773-7.461, p=0.01, respectively) in multivariate analysis. The IABPD was shown as an independent predictor of poor collateral circulation in patients with STEMI who underwent p-PC.

Increased Plasma Non-High-Density Lipoprotein Levels and Poor Coronary Collateral Circulation in Patients With Stable Coronary Artery Disease.

This study investigated the relationship between coronary collateral circulation (CCC) and non-high-density lipoprotein cholesterol (non-HDL-C) in patients with stable coronary artery disease (CAD). Coronary collateral circulation plays a critical role in supporting blood flow, particularly in the ischemic myocardium. Previous studies show that non-HDL-C plays a more important role in the formation and progression of atherosclerosis than do standard lipid parameters. A total of 226 patients with stable CAD and stenosis of more than 95% in at least 1 epicardial coronary artery were included in the study. Rentrop classification was used to assign patients into group 1 (n = 85; poor collateral) or 2 (n = 141; good collateral). To adjust for the observed imbalance in baseline covariates between study groups, propensity-score matching was used. Covariates were diabetes, Gensini score, and angiotensin-converting enzyme inhibitor use. In the propensity-matched population, the plasma non-HDL-C level (mean [SD], 177.86 [44.0] mg/dL vs 155.6 [46.21] mg/dL; P = .001) was statistically higher in the poor-collateral group. LDL-C (odds ratio [OR], 1.23; 95% CI, 1.11-1.30; P = .01), non-HDL-C (OR, 1.34; 95% CI, 1.20-1.51; P = .01), C-reactive protein (OR, 1.21; 95% CI, 1.11-1.32; P = .03), systemic immune-inflammation index (OR, 1.14; 95% CI, 1.05-1.21; P = .01), and C-reactive protein to albumin ratio (OR, 1.11; 95% CI, 1.06-1.17; P = .01) remained independent predictors of CCC in multivariate logistic regression analysis. Non-HDL-C was an independent risk factor for developing poor CCC in stable CAD.

Correlation between Serum Erythropoietin and Cerebral Collateral Flow in Acute Ischemic Stroke Patient.

Erythropoietin (EPO), which is associated with anemia, exerts neuroprotective effects in ischemic stroke. In cases of stenosis or narrowing of the main cerebral blood vessel, the prognosis is favorable if collateral blood circulation is well developed in acute stroke. Several studies have investigated the relationship between EPO administration and stroke outcomes. The present study investigated the correlation between serum EPO level and cerebral collateral circulation, which could result in favorable clinical outcomes. The study subjects were patients diagnosed with acute ischemic stroke who underwent initial brain magnetic resonance imaging between January 2020 and March 2022. Following brain computed tomography perfusion for collateral flow, serum EPO levels were measured. Collaterals were assessed according to the Mass system and divided into good collateral (GC) or poor collateral (PC) groups. Serum EPO levels were determined using a chemiluminescence immunoassay method. A correlation coefficient analysis was conducted to determine the correlation between serum EPO levels and GC. A receiver operating characteristic curve analysis determined the cutoff value of EPO for GC. Serum EPO levels were significantly higher in the GC than that in the PC group (P<0.05). The cut-off level of serum EPO for a good outcome was 9.1 mIU/mL. A high serum EPO (>9.1 mIU/mL) could be a marker of GC in patients with acute ischemic stroke that predicts good clinical outcomes.

Interplay between anemia parameters and collateral status in patients who undergo mechanical thrombectomy

IntroductionAnemia is associated with higher morbidity and mortality, but its association with acute ischemic stroke (AIS) is not well established. We aim to determine the association of five-day anemia parameters with clinical outcomes in patients with an AIS, depending on their pre-mechanical thrombectomy (MT) collateral status. MethodsWe performed a retrospective chart review of patients who underwent MT at a comprehensive stroke center from 7/2014 to 12/2020. The patients were divided into good and poor collateral groups depending on their pre-MT collateral status. A blinded board-certified neuroradiologist used collateral grading scale of Maas ≥ 3 to designate good collaterals on the pre-MT CT Angiogram. A binary logistic regression analysis was performed, controlling for the baseline parameters, with the five-day anemia parameters as predictors. The outcomes were functional independence (mRS 0–2), mortality, and early neurological improvement. ResultsA total of 220 met the inclusion criteria. 94 (42.72 %) patients had good collaterals, while 126 (57.27 %) patients had poor collaterals. In the multivariable analysis, for patients with good collaterals, the higher values of five-day mean Hb (12.41 ± 1.87 vs 11.32 ± 1.95; OR, 0.72; 95 % CI, 0.54–0.95; P 0.018), five-day mean HCT (37.43 ± 5.1 vs 34.35 ± 5.5; OR, 0.89; 95 % CI, 0.81–0.98; P 0.018) and lower values of the difference between peak and trough values of Hb (1.75 ± 1.15 vs 2.41 ± 1.35; OR, 1.71; 95 % CI, 1.07–2.74; P 0.025) were associated with functional independence. For patients with poor collaterals, there was no association between five-day mean Hb, mean HCT parameters with functional independence, lower mortality, and early neurological improvement. ConclusionOur study was suggestive of an association between higher mean values of Hb and HCT over a five-day period and good clinical outcomes in patients with good collaterals who undergo MT for an anterior circulation LVO. This association was not found in the poor collateral group.

Association of 24-hour blood pressure parameters post-thrombectomy with functional outcomes according to collateral status

IntroductionElevation of blood pressure (BP) after mechanical thrombectomy (MT) can theoretically restore perfusion to the ischemic brain tissue, but it comes at a risk of causing reperfusion injury. We aim to determine the association of 24-h post-MT BP parameters with clinical outcomes depending on the pre-MT collateral status. MethodsWe performed a retrospective chart review of patients who underwent MT at a comprehensive stroke center from 7/2014 to 12/2020. The patients were divided into good versus poor collateral groups depending on their collateral status. A board-certified neuroradiologist, who was blinded to the clinical outcomes, used collateral grading score of Miteff ≥3 to designate good collaterals on the pre-MT CT Angiogram. A binary logistic regression analysis was performed, controlling for baseline parameters, with the 24-h post-MT BP parameters as predictors. The outcomes were functional dependence [3-month mRS (3–6)] and mortality. ResultsA total of 220 met the inclusion criteria. In the multivariable analysis, for patients with poor collaterals, the parameters of higher mean SBP (131.7 ± 12.7 vs. 122.3 ± 14.2; OR, 1.06; 95% CI, 1.01–1.11; P 0.022), higher mean MAP (91.2 ± 8.2 vs. 86.1 ± 6.3; OR, 1.13; 95% CI, 1.03–1.23; P 0.015) and a higher maximum SBP (156.3 ± 13.7 vs. 145.3 ± 19.1; OR, 1.05; 95% CI, 1.01–1.1; P 0.019) were significantly associated with functional dependence at 3-months. For patients with good collaterals, the parameters of lower 24-h mean DBP (69.1 ± 11.1 vs. 73.8 ± 11 95% CI, OR, 0.96; 95% CI, 0.92–1; P 0.025) was significantly associated with higher mortality at 3-months. Conclusion: Our study demonstrates that there is a significant difference with respect to certain 24-h post-MT BP parameters in patients on clinical outcomes depending on their collateral status. In our study, some higher BP parameters were associated with worse outcomes in patients with a poor collateral profile, however, this effect was not replicated in patients with a good collateral profile.

A Deep Learning-Based Automatic Collateral Assessment in Patients with Acute Ischemic Stroke.

This study aimed to develop a supervised deep learning (DL) model for grading collateral status from dynamic susceptibility contrast magnetic resonance perfusion (DSC-MRP) images from patients with large vessel occlusion (LVO) acute ischemic stroke (AIS) and compare its performance against experts' manual grading. Among consecutive LVO-AIS at three medical center sites, DSC-MRP data were processed to generate collateral flow maps consisting of arterial, capillary, and venous phases. With the use of expert readings as a reference, a DL model was developed to analyze collateral status with output classified into good and poor grades. The resulting model was externally validated in a later-collected population from one medical center site. The model was trained on 255 patients and externally validated on 72 patients. In the all-site internal validation population, DL grading of good collateral probability yielded a c statistic of 0.91; in the external validation population, the c statistic was 0.85. In the external validation population, there was moderate agreement between the experts' grades and DL grades (kappa = 0.53, 95% CI = 0.32-0.73, p < 0.0001). Day 7 infarct growth volume was higher in DL-graded poor collateral group than good collateral group patients (median volume [26mL vs. 6mL], p = 0.01) in patients with successful reperfusion (modified treatment in cerebral infarction (mTICI) = 2b-3). In all patients with a 90-day modified Rankin Scale (mRS) score, there was a shift to more favorable outcomes in the good collateral group, with a common odds ratio of 2.99 (95% CI = 1.89-4.76, p < 0.0001). The DL-based collateral grading was in good agreement with expert manual grading in both development and validation populations. After exclusion of patients with large infarct volume, early reperfusion is more likely to benefit patients with the poor collateral flow, and the DL method has the potential to aid the assessment of collateral status.

The Potential Mechanism Behind Native and Therapeutic Collaterals in Moyamoya

Background and PurposeTo explore the genetic basis and molecular mechanism of native arteriogenesis and therapeutic synangiosis in moyamoya disease (MMD).MethodsAn angiography-based study using patients from a prospective trial of encephaloduroarteriosynangiosis (EDAS) surgery was performed. The spontaneous collaterals grades were evaluated according to the system described by a new grading system. Blood samples were collected from all the recruited patients before EDAS and during the second hospitalization 3 months post-EDAS. We performed Boolean analysis using a combination of specific cell surface markers of CD34briCD133+CD45dimKDR+. Genotyping of p.R4810K was also performed. The correlation of age, sex, initial symptoms at diagnosis, collateral grade, Suzuki stages, the RNF213 genotype, time to peak (TTP), and endothelial progenitor cell (EPC) count with good collateral circulation was evaluated.ResultsEighty-five patients with MMD were included in this study. The mutation rate of RNF213 p.R4810K in our study was 25.9% (22/85). The heterozygous mutations were occurred significantly more frequently in the cases that were presented with infarction, worse neurological status, severe posterior cerebral artery (PCA) stenosis, and longer TTP delay. Further, the heterozygous mutations occurred significantly more frequently in the poor collateral stage group. Lower grades were significantly correlated with severe ischemia symptoms, worse neurological status, and a longer TTP delay. The post-operative angiographic findings showed that a good Matsushima grade was correlated with heterozygous mutations, a lower collateral stage, and a longer TTP delay. The CD34briCD133+CD45dimKDR+ cell count in patients 3 months post-EDAS was significantly higher as compared to the count before EDAS in the good Matsushima grade group. However, this change was not observed in the poor Matsushima grade group.ConclusionsThese data imply that mutations of RNF213 p.R4810K affect the establishment of spontaneous collateral circulation, and EPCs are involved in the process of formation of new EDAS collaterals.

Collateral status reperfusion and outcomes after endovascular therapy: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) Registry

BackgroundStudies have suggested that collateral status modifies the effect of successful reperfusion on functional outcome after endovascular therapy (EVT). We aimed to assess the association between collateral status and EVT...

Matrix metallopeptidase 9 and placental growth factor may correlate with collateral status based on whole-brain perfusion combined with multiphase computed tomography angiography

ABSTRACT Objective The aim of this study was to find out the relationship between serum biomarkers and cerebral collateral status in acute ischemic stroke with cerebral large artery atherosclerosis. Methods We enrolled patients with ischemic stroke due to large artery atherosclerosis within 7 days of symptom onset, age 18–80 years, from August 2016 to December 2017. Twelve biomarkers representing different pathophysiological mechanisms were tested after admission. Whole-brain perfusion combined with multiphase computed tomography angiography was performed to assess cerebral collateral structure and function. Results Fifty-two patients completed the test of candidate biomarkers and recruited in this study. The mean age was 55.0 (11.1) years, 42 (80.8%) patients were male, 20 (38.5%) had poor collateral, 36 (69.2%) patients had anterior circulation stenosis or occlusion. Compared with poor collateral group, the level of MMP-9 (135,475.00 pg/ml vs. 103,612.00 pg/ml, p = 0.040) and PGF (5.75 pg/ml vs. 3.46 pg/ml, p = 0.046) was significantly higher in good collateral group. The adjusted OR (95%CI) of MMP-9 and PGF were 5.533 (1.10–27.74, p = 0.038), 7.73 (1.41–42.39, p = 0.018), respectively. sTie-2 level had a positive correlation with proportion of Tmax 4–6 (r = 0.302, p = 0.033) and HMW-KGN had negative correlation with proportion of Tmax 6–8 (r = −0.338, p = 0.02). After adjustment, the correlation of sTie-2 level and proportion of Tmax 4–6 was statistically significant (p = 0.003), and correlation of HMW-KGN and Tmax6-8 was not statistically significant (p = 0.056). Discussion Serum PGF and MMP-9 levels may correlate with collateral status based on MP-CTA in acute ischemic stroke patients with cerebral large artery atherosclerosis. Higher PGF and MMP-9 concentration associated with good collateral status.

Encephaloduroarteriosynangiosis (EDAS) treatment of moyamoya syndrome: evaluation by computed tomography perfusion imaging

To explore the value of computed tomography perfusion (CTP) imaging for evaluating the efficacy of encephaloduroarteriosynangiosis (EDAS) treatment of moyamoya syndrome (MMS). Forty-three patients with MMS (48 hemispheres) who received EDAS treatment were examined using CTP and DSA before and after surgery. CTP of the ipsilateral cortex, contralateral mirror area, and pons region were measured, and the relative cerebral blood flow (rCBF) and volume (rCBV), mean transit time (rMTT), and time-to-peak (rTTP) were calculated. Based on postoperative DSA, 48 hemispheres were apportioned to two groups based on rich (grades 2, 3) or poor (grades 0, 1) collateral vessel formation, and the pre- and post-operative differences in perfusion changes were compared. The association between clinical outcome, CTP, and the degree of DSA collateral vessels was explored. rCBF and rMTT significantly improved in both the poor and rich collateral vessel formation groups (n = 21 and 27, respectively), while rTTP significantly improved only in the latter. Postoperative CTP improved in the rich and the grade 1 collateral vessel groups (p < 0.01). The clinical improvement was consistent with the improvement of CTP (p = 0.07), but less consistent with the degree of collateral angiogenesis (p = 0.003). CTP can quantitatively evaluate the improvement of brain tissue perfusion in the operated area after EDAS. Brain tissue perfusion in operated areas improved regardless of postoperative rich or poor collateral vessel formation observed via DSA. A significant improvement in rTTP in the operated area may indicate the formation of abundant collateral vessels. • CTP showed that brain tissue perfusion in the operated area after EDAS improved regardless of rich or poor collateral vessel formation observed via DSA. • Significant improvement of rTTP in the operated area may indicate the formation of abundant collateral vessels.

Ischemic Tolerance Evaluated by Computed Tomography Perfusion During Balloon Test Occlusion

Abstract Objectives: Balloon test occlusion (BTO) is performed to evaluate ischemic tolerance for large and giant cerebral aneurysms and head and neck tumors that may require parent artery occlusion. However, ischemic tolerance for the temporary test occlusion does not always guarantee a tolerance for permanent occlusion. In this study, we evaluated the utility of computed tomography (CT) perfusion during BTO to quantify ischemic tolerance for detecting delayed ischemic stroke. Materials and Methods: Forty-one patients who underwent BTO for the internal carotid artery were included. The correlations between the parameters of CT perfusion and collateral angiographic appearance or stump pressure during BTO were evaluated. The cerebral blood flow (CBF), cerebral blood volume, mean transit time (MTT), and time to peak (TTP) were obtained through CT perfusion, and the asymmetry ratios were determined. Collateral angiographic appearances were categorized into 5 grades (0-4). Results: The collateral angiographic appearance showed moderate correlations with CBF, MTT, and TTP that was significant. Of these, the absolute value of the correlation coefficient was the highest for MTT. MTT also showed a moderate correlation with stump pressure. CBF and MTT were significantly different between the poor collateral group (grades 2 and 3) and the good collateral group (grade 4). Based on the MTT, the good collateral group was identified with high sensitivity (75.0%) and specificity (81.2%). Conclusions: In BTO, the MTT obtained through CT perfusion showed a correlation with collateral angiographic appearance and stump pressure. Thus, the MTT might be useful to quantify ischemic tolerance for detecting delayed ischemic stroke.

Correlation of plasma vitamin D levels with coronary collateral circulation

Introduction: In patients with coronary chronic total occlusion (CTO), adequate coronary collateral circulation (CCC) supports myocardial tissue versus ischemia. Vitamin D deficiency is a risk factor for osteoporosis and other chronic diseases, including type 1 diabetes, hypertension, metabolic syndrome and ischemic heart disease. Objectives: In this study, we evaluated whether coronary CTO is associated with serum levels of vitamin D and CCC. Patients and Methods: Around 216 patients with coronary CTO at coronary angiography were incorporated in this investigation. Serum 25(OH)D level and low-density lipoprotein (LDL-C), triglyceride (TG), total cholesterol, fasting blood sugar (FBS), serum creatinine, high-density lipoprotein (HDL-C), were assessed before angiography. Patients were divided into a poor coronary collateral circulation group (Rentrop grades 0-1) or good coronary collateral circulation group (Rentrop grades 2-3). Results: A total of 216 patients (mean age 61.48±9.5 years) were included in this study. Regression analysis results displayed that serum 25(OH)D level had a significant correlation with CCC according to Rentrop scoring system (P&lt;0.0001). We also found that variables such as gender (P=0.05), HDL-C (P=0.01) and serum creatinine (P=0.05) were a predictor for CCC. This model described 33% of the CCC’s variance in the study patients. Besides, in the analysis of clinical levels of vitamin D, it can be stated that the probability of having a high degree of Rentrop criterion in the patients with adequate level of vitamin D is 24.5 times higher than the patients with vitamin D deficiency (P&lt;0.001). Conclusion: The results of this study emphasize the importance of informing patients with CTO commonly associated with serum vitamin D level.

Ischemic Tolerance Evaluated by Computed Tomography Perfusion during Balloon Test Occlusion

Objectives: Balloon test occlusion (BTO) is performed to evaluate ischemic tolerance for large and giant cerebral aneurysms and head and neck tumors that may require parent artery occlusion. However, ischemic tolerance for the temporary test occlusion does not always guarantee a tolerance for permanent occlusion. In this study, we evaluated the utility of computed tomography (CT) perfusion during BTO to quantify ischemic tolerance for detecting delayed ischemic stroke. Materials and Methods: Forty-one patients who underwent BTO for the internal carotid artery were included. The correlations between the parameters of CT perfusion and collateral angiographic appearance or stump pressure during BTO were evaluated. The cerebral blood flow (CBF), cerebral blood volume, mean transit time (MTT), and time to peak (TTP) were obtained through CT perfusion, and the asymmetry ratios were determined. Collateral angiographic appearances were categorized into 5 grades (0-4). Results: The collateral angiographic appearance showed moderate correlations with CBF, MTT, and TTP that was significant. Of these, the absolute value of the correlation coefficient was the highest for MTT. MTT also showed a moderate correlation with stump pressure. CBF and MTT were significantly different between the poor collateral group (grades 2 and 3) and the good collateral group (grade 4). Based on the MTT, the good collateral group was identified with high sensitivity (75.0%) and specificity (81.2%). Conclusions: In BTO, the MTT obtained through CT perfusion showed a correlation with collateral angiographic appearance and stump pressure. Thus, the MTT might be useful to quantify ischemic tolerance for detecting delayed ischemic stroke.

Association of atherosclerotic plaque features with collateral circulation status in elderly patients with chronic carotid stenosis.

ObjectiveTo determine the association of carotid plaque features with collateral circulation status in elderly patients with moderate to severe carotid stenosis.MethodsElderly patients (> 60 years) with moderate to severe carotid stenosis were recruited and categorized into good and poor collateral circulation groups, and underwent magnetic resonance imaging and computed tomography imaging. The carotid plaque features including lipid-rich necrotic core, intraplaque hemorrhage, calcification, and fibrous cap rupture (FCR) were evaluated, and maximum wall thickness, normalized wall index (NWI), and luminal stenosis were measured. The association between these variables and collateral circulation status was analyzed.ResultsOf the 97 patients (78 males, mean age: 69.0 ± 6.1 years), 19 (19.6%) had poor collaterals. The poor collateral group had a significantly higher NWI (93.7% ± 5.0% vs. 89.0% ± 7.9%, P = 0.011), a greater extent of stenosis (80.0% ± 11.4% vs. 75.3% ± 9.4%, P = 0.036) and FCR (84.2% vs. 55.1%, P = 0.020) compared with good collateral group. Carotid NWI (OR = 3.83, 95% CI: 1.36–10.82, P = 0.011) and more FCR (OR = 6.77, 95% CI: 1.35–33.85, P = 0.020) were associated with poor collateral circulation after adjustment for the confounding factors. The combination of NWI, FCR, systolic blood pressure, and triglycerides had the highest area-under-the-curve (AUC = 0.85) for detection of poor collaterals.ConclusionsCarotid plaque features, specifically NWI and FCR, are independently associated with poor collateral circulation, and the combination of carotid plaque features and traditional risk factors has a stronger predictive value for poor collateral circulation than plaque features alone.

Association between electrocardiographic parameters and collateral circulation in patients with chronic total occlusion

Aim: In patients with chronic total occlusion (CTO), negative cardiovascular outcomes (angina, more frequent ventricular arrhythmias, higher mortality) and reduced survival have been demonstrated. The association between several electrocardiogram (ECG) markers, revealing individuals at high risk for ventricular arrhythmia, and collateral has been investigated in different studies in coronary artery disease patients. In this study, we aimed to investigate the association between the electrocardiographic parameters between good coronary collateral group and poor coronary collateral group in CTO patients with PCI.Material and Methods: Patients retrospectively implemented CTO PCI to those with symptomatic symptoms of myocardial ischemia or with the exact sign of ischemia in the CTO area. The patients were divided into 2 groups according to the Rentrop class: group 1 (Rentrop 0 and 1) and group 2 (Rentrop 2 and 3). Baseline characteristics, laboratory and ECGs, procedural data, and outcome data were retrospectively collected. Results: In this study included 59 CTO patients undergoing PCI. Mean age was 61.0±10.3 years and 43 (72.9%) of patients were male, and PCI success was 69.4%. While 22 (37.2%) of the patients were poor collateral group 1 (Rentrop 0 and 1), the remaining 37 (62.3%) of them were good collateral group 2 (Rentrop 2 and 3). There was a significant difference, in poor and good collateral groups, QT dispersion (77.2±27.9 vs 66.5±22.5, p: 0.041, respectively), QTc dispersion (82.1±26.9 vs 70.4±23.9, p: 0.034, respectively), and the presence of fQRS (63.6% vs 43.2, p: 0.027, respectively). But there was no statistically difference in P wave dispersion (48.0±9.5 vs 47.2±11.3, p: 0.796). Correlation analysis reported the association between Rentrop classification and Syntax score (r: -0.397, p: 0.002), LDL-C (r: -0.198, p: 0.025), QT dispersion (r: -0.156, p: 0.045), QTc dispersion (r: -0.176, p: 0.037), and the presence of fQRS (r: 0.234, p: 0.021) were statistically significant.Conclusion: We suggest that some ECG parameters are an important, easy, simple, and cost effective tool and can be beneficial in predicting the poor or good collateral in patients with CTO.