Collateral circulation
Collateral circulation
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DOI：
10.1161/01.str.0000086465.41263.06
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发表时间：
2003-09-01
期刊：
影响因子：
8.3
通讯作者：
Liebeskind, DS
中科院分区：
文献类型：
--
作者：
Liebeskind, DS
背景-侧支循环在脑缺血的病理生理学中起着关键作用。目前对侧支循环的了解仍然很少，很大程度上是因为先前评估这些微小脑血流路径的方法存在局限性。综述总结 - 侧支循环的解剖学描述通常集中于 Willis 环的更近端吻合，忽略了软脑膜血管提供的次级侧支通路。侧支血管的病理生理学募集可能取决于多种代偿性血流动力学、代谢和神经机制的时间过程。这些保护性血管通路的后续耐力可能决定缺血性损伤的严重程度。利用提供血管造影信息和灌注数据的先进神经影像模式对侧支循环进行表征，可以阐明侧支血流的关键决定因素。有关侧支循环状态的此类信息可用于指导治疗干预。通过对侧支血流的常规评估也可以改善预后和风险分层。结论——通过进一步完善将血管造影结果与灌注状态相关联的神经影像学模式，可以大大增强对侧支循环的当代理解，为未来的治疗和预后应用提供基础。
Background-The collateral circulation plays a pivotal role in the pathophysiology of cerebral ischemia. Current knowledge of the collateral circulation remains sparse, largely because of prior limitations in methods for evaluation of these diminutive routes of cerebral blood flow.Summary of Review-Anatomic descriptions of the collateral circulation often focus on more proximal anastomoses at the circle of Willis, neglecting secondary collateral pathways provided by leptomeningeal vessels. Pathophysiological recruitment of collateral vessels likely depends on the temporal course of numerous compensatory hemodynamic, metabolic, and neural mechanisms. Subsequent endurance of these protective vascular pathways may determine the severity of ischemic injury. Characterization of the collateral circulation with advanced neuroimaging modalities that provide angiographic information and perfusion data may elucidate critical determinants of collateral blood flow. Such information on the status of the collateral circulation may be used to guide therapeutic interventions. Prognostication and risk stratification may also be improved by routine evaluation of collateral blood flow.Conclusions-Contemporary understanding of the collateral circulation may be greatly enhanced through further refinement of neuroimaging modalities that correlate angiographic findings with perfusion status, providing the basis for future therapeutic and prognostic applications.