Collateral Flow: Prolonging the Ischemic Penumbra.
Collateral Flow: Prolonging the Ischemic Penumbra.
复制标题
侧支血流：延长缺血半暗带。
DOI：
10.1007/s12975-023-01126-8
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发表时间：
2023
影响因子：
6.9
通讯作者：
Lee,Jin-Moo
中科院分区：
文献类型：
--
作者：
Dhar,Rajat;Yu,Wengui;Yenari,Midori;Lee,Jin-Moo
在过去的四十年里，中风护理的心态已经从一种感知治疗虚无主义转变为一种以再灌注为导向的介入方法。在卒中领域发生显著变化的同时，人们认识到脑侧支循环对卒中病理生理和预后至关重要。五六十年前的实验研究表明，缺血核心和潜在的半暗带[1]之间存在区别，再加上灵长类动物在大血管闭塞[1]后测量这些区域的脑血流量。在20世纪80年代，Del Zoppo等人提出，溶栓是卒中的一种可行选择，其前提是存在可抢救的半暗带侧支流，这为干预提供了宝贵的时间。替代的内源性途径可以绕过急性或慢性狭窄或闭塞的想法并不新鲜；Denny-Brown在1957年bbb上评论了络的重要性和血液动力学操作改善缺血性症状的能力。事实上，他说：“在栓塞中，梗死区域也有很大的变化，这明显是由于侧枝供应的变化。因此，有必要更多地了解大脑侧支血管的动态调节……”然而，在20世纪后半叶，科学研究断断续续地进展，但在过去的十年中，随着血管内干预的兴起，科学研究呈指数级增长，现在每年有300多篇关于脑侧支循环和中风的论文发表。成像技术的进步，现在可以看到闭塞；相关的脑血管解剖和每位患者的灌注状态加速了向精准脑卒中护理的转变。在部分患者中，半影成像将溶栓窗口延长至9小时。类似地，具有里程碑意义的研究也证实了基于半暗带状态有针对性地选择大血管闭塞的患者进行血栓切除术[7,8]。这种半影动力学的异质性归因于侧支循环及其在面对闭塞时的招募在患者之间差异很大。随着认识到了解侧枝循环将使更精确的治疗选择和预后成为了解侧枝循环病理生理学以及如何测量和操纵它的动力。正是朝着这个目标，这个特刊的翻译中风研究被设想。我们试图将脑侧支循环各方面的专家聚集在一起，撰写权威综述，总结这些领域的科学知识，重点关注该系统如何促进缺血演变
The mindset of stroke care has shifted over the past four decades from one of perceived therapeutic nihilism to a reperfusion-oriented interventional approach. In parallel with this remarkable transformation in the stroke landscape has been the realization that the cerebral collateral circulation is critically important to stroke pathophysiology and outcomes. Experimental studies dating back five or six decades suggested a distinction between an ischemic core and a potentially salvageable penumbra [1], coupled with primate studies measuring cerebral blood flow in these zones after large vessel occlusion [2]. In the 1980s, the proposal that thrombolysis was a viable option for stroke by Del Zoppo and others was predicated on existence of collateral flow to a salvageable penumbra that afforded precious time to intervene [3]. The idea that alternate endogenous pathways may be recruited to bypass acute or chronic stenoses or occlusions is not new; Denny-Brown commented on the importance of collaterals and the ability of hemodynamic manipulations to improve ischemic symptoms in 1957 [4]. In fact, he made the statement,“In embolism the area of infarction is also greatly variable, manifestly due to variations in collateral supply. It is, therefore, desirable to learn more of the dynamic adjustments of collateral vessels in the brain…”[5]. However, scientific investigation advanced in fits and starts through the latter part of the twentieth century, but has risen exponentially over the past decade with the rise of endovascular interventions, now with over 300 papers being published annually on the cerebral collateral circulation and stroke.Advances in imaging that now allow visualization of the occlusion; associated cerebral vascular anatomy and the perfusion status of each patient have accelerated the transformation to precision stroke care. Penumbral imaging extended the thrombolytic window to 9 h in select patients [6]. Similarly, targeted patient selection for thrombectomy of large vessel occlusions based on status of the penumbra was proven in landmark studies [7, 8]. This heterogeneity in penumbral dynamics was attributed to the fact that collateral circulation and its recruitment in the face of occlusion differed widely between patients. With the realization that understanding collaterals would enable more precise therapeutic selection and prognostication came the drive to understand the pathophysiology of the collateral circulation and how it can be measured and manipulated. It is toward that goal that this Special Issue of Translational Stroke Research was conceived. We sought to bring together experts in various aspects of the cerebral collateral circulation to write authoritative reviews summarizing the scientific knowledge in these domains, focusing on how this system contributes to the Evolving Ischemic