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For acute ischemic stroke patients with large vessel occlusion (LVO), the use of CT and magnetic resonance perfusion imaging to define the ischemic core and penumbra has overshadowed the importance of evaluating the cerebral collateral circulation.1 In part, this reflects the relative ease with which perfusion imaging can now be interpreted, particularly with quantitative commercial software such as RAPID and Olea Sphere. However, collaterals remain an important predictor of clinical outcome and response to acute stroke therapy.2–4 Many factors likely contribute to the observed phenotypic variation in cerebral collaterals, including both genetic and metabolic determinants,5,6 but substantial knowledge gaps remain. Why do patients exhibit such a wide variation in the extent of collaterals? Can we recruit collaterals to protect the penumbra after ischemic stroke? When are collaterals recruited after LVO, and why do they subsequently fail in selected patients?
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Collateral response modulates the time–penumbra relationship in proximal arterial occlusions 163
- Copyright © 2017 American Academy of Neurology
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