Occult blood flow patterns distal to an occluded artery in acute ischemic stroke

• Published in: Journal of cerebral blood flow and metabolism Vol. 42; no. 2; pp. 292 - 302
• Main Authors: Arrarte Terreros, Nerea, van Willigen, Bettine G, Niekolaas, Wera S, Tolhuisen, Manon L, Brouwer, Josje, Coutinho, Jonathan M, Beenen, Ludo FM, Majoie, Charles BLM, van Bavel, Ed, Marquering, Henk A
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.02.2022
• Subjects: Aged; Blood Flow Velocity; Cerebral Angiography; Cerebral Arteries - diagnostic imaging; Cerebral Arteries - physiopathology; Collateral Circulation; Computed Tomography Angiography; Humans; Ischemic Stroke - diagnostic imaging; Ischemic Stroke - physiopathology; Male; Middle Aged; Original; blood flow quantification; collateral circulation; dynamic CTA; Acute ischemic stroke; thrombus permeability
• ISSN: 0271-678X; 1559-7016
• DOI: 10.1177/0271678X211044941

Residual blood flow distal to an arterial occlusion in patients with acute ischemic stroke (AIS) is associated with favorable patient outcome. Both collateral flow and thrombus permeability may contribute to such residual flow. We propose a method for discriminating between these two mechanisms, based on determining the direction of flow in multiple branches distal to the occluding thrombus using dynamic Computed Tomography Angiography (dynamic CTA). We analyzed dynamic CTA data of 30 AIS patients and present patient-specific cases that identify typical blood flow patterns and velocities. We distinguished patterns with anterograde (N = 10), retrograde (N = 9), and both flow directions (N = 11), with a large variability in velocities for each flow pattern. The observed flow patterns reflect the interplay between permeability and collaterals. The presented method characterizes distal flow and provides a tool to study patient-specific distal tissue perfusion.