Sustaining cerebral perfusion in intracranial atherosclerotic stenosis: The roles of antegrade residual flow and leptomeningeal collateral flow

Linfang Lan; Xinyi Leng; Vincent Ip; Yannie  Soo; Jill Abrigo; Haipeng Liu; Florence  Fan; Sze Ho Ma; Karen  Ma; Bonaventure Y.M.  Ip; Ka Lung Chan; Vincent C.T. Mok; David S. Liebeskind; prince wal; Thomas Wai Hong Leung

doi:10.1177/0271678X18805209

Sustaining cerebral perfusion in intracranial atherosclerotic stenosis: The roles of antegrade residual flow and leptomeningeal collateral flow

Linfang Lan, Xinyi Leng, Vincent Ip, Yannie Soo, Jill Abrigo, Haipeng Liu, Florence Fan, Sze Ho Ma, Karen Ma, Bonaventure Y.M. Ip, Ka Lung Chan, Vincent C.T. Mok, David S. Liebeskind, prince wal, Thomas Wai Hong Leung

Research output: Contribution to journal › Article › peer-review

56 Citations (Scopus)

Abstract

We aimed to investigate the roles of antegrade residual flow and leptomeningeal collateral flow in sustaining cerebral perfusion distal to an intracranial atherosclerotic stenosis (ICAS). Patients with apparently normal cerebral perfusion distal to a symptomatic middle cerebral artery (MCA)-M1 stenosis were enrolled. Computational fluid dynamics models were built based on CT angiography to obtain a translesional pressure ratio (PR) to gauge the residual antegrade flow. Leptomeningeal collaterals (LMCs) were scaled on CT angiography. Cerebral perfusion metrics were obtained in CT perfusion maps. Among 83 patients, linear regression analyses revealed that both translesional PR and LMC scale were independently associated with relative ipsilesional mean transit time (rMTT). Subgroup analyses showed that ipsilesional rMTT was significantly associated with translesional PR (p < 0.001) rather than LMC scale in those with a moderate (50–69%) MCA stenosis, which, however, was only significantly associated with LMC scale (p = 0.051) in those with a severe (70–99%) stenosis. Antegrade residual flow and leptomeningeal collateral flow have complementary effects in sustaining cerebral perfusion distal to an ICAS, while cerebral perfusion may rely more on the collateral circulation in those with a severe stenosis.

Original language	English
Pages (from-to)	126-134
Number of pages	9
Journal	Journal of Cerebral Blood Flow and Metabolism
Volume	40
Issue number	1
Early online date	23 Oct 2018
DOIs	https://doi.org/10.1177/0271678X18805209
Publication status	Published - 1 Jan 2020
Externally published	Yes

Funder

This work was supported by Young Scientists Fund (Reference No. 81601000), National Natural Science Foundation of China; General Research Fund (Reference No. 14117414), Research Grants Council of Hong Kong; Young Elite Scientists Sponsorship Program (Reference No. 2017QNRC001), China Association for Science and Technology; and Health and Medical Research Fund (Reference No. 01120466), Food and Health Bureau, Hong Kong SAR, China.

Funding

This work was supported byYoung Scientists Fund (Reference No. 81601000), National Natural Science Foundation of China; General Research Fund (Reference No. 14117414), Research Grants Council of Hong Kong; Young Elite Scientists Sponsorship Program (Reference No. 2017QNRC001), China Association for Science and Technology; and Health and Medical Research Fund (Reference No. 01120466), Food and Health Bureau, Hong Kong SAR, China.

Funders	Funder number
Research Grants Council of Hong Kong	14117414
China Association for Science and Technology	2017QNRC001
National Natural Science Foundation of China	81601000
Food and Health Bureau	01120466

Keywords

Cerebral perfusion
antegrade flow
collateral circulation
computational fluid dynamics
intracranial atherosclerotic stenosis

ASJC Scopus subject areas

Neurology
Clinical Neurology
Cardiology and Cardiovascular Medicine

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Lan, L., Leng, X., Ip, V., Soo, Y., Abrigo, J., Liu, H., Fan, F., Ma, S. H., Ma, K., Ip, B. Y. M., Chan, K. L., Mok, V. C. T., Liebeskind, D. S., wal, P., & Leung, T. W. H. (2020). Sustaining cerebral perfusion in intracranial atherosclerotic stenosis: The roles of antegrade residual flow and leptomeningeal collateral flow. Journal of Cerebral Blood Flow and Metabolism, 40(1), 126-134. https://doi.org/10.1177/0271678X18805209

Lan, L, Leng, X, Ip, V, Soo, Y, Abrigo, J, Liu, H, Fan, F, Ma, SH, Ma, K, Ip, BYM, Chan, KL, Mok, VCT, Liebeskind, DS, wal, P & Leung, TWH 2020, 'Sustaining cerebral perfusion in intracranial atherosclerotic stenosis: The roles of antegrade residual flow and leptomeningeal collateral flow', Journal of Cerebral Blood Flow and Metabolism, vol. 40, no. 1, pp. 126-134. https://doi.org/10.1177/0271678X18805209

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abstract = "We aimed to investigate the roles of antegrade residual flow and leptomeningeal collateral flow in sustaining cerebral perfusion distal to an intracranial atherosclerotic stenosis (ICAS). Patients with apparently normal cerebral perfusion distal to a symptomatic middle cerebral artery (MCA)-M1 stenosis were enrolled. Computational fluid dynamics models were built based on CT angiography to obtain a translesional pressure ratio (PR) to gauge the residual antegrade flow. Leptomeningeal collaterals (LMCs) were scaled on CT angiography. Cerebral perfusion metrics were obtained in CT perfusion maps. Among 83 patients, linear regression analyses revealed that both translesional PR and LMC scale were independently associated with relative ipsilesional mean transit time (rMTT). Subgroup analyses showed that ipsilesional rMTT was significantly associated with translesional PR (p < 0.001) rather than LMC scale in those with a moderate (50–69%) MCA stenosis, which, however, was only significantly associated with LMC scale (p = 0.051) in those with a severe (70–99%) stenosis. Antegrade residual flow and leptomeningeal collateral flow have complementary effects in sustaining cerebral perfusion distal to an ICAS, while cerebral perfusion may rely more on the collateral circulation in those with a severe stenosis.",

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AU - Soo, Yannie

AU - Abrigo, Jill

AU - Liu, Haipeng

AU - Fan, Florence

AU - Ma, Sze Ho

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AU - Ip, Bonaventure Y.M.

AU - Chan, Ka Lung

AU - Mok, Vincent C.T.

AU - Liebeskind, David S.

AU - wal, prince

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Sustaining cerebral perfusion in intracranial atherosclerotic stenosis: The roles of antegrade residual flow and leptomeningeal collateral flow

Abstract

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ASJC Scopus subject areas

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