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 journalArticlepeer-review

46 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 languageEnglish
Pages (from-to)126-134
Number of pages9
JournalJournal of Cerebral Blood Flow and Metabolism
Volume40
Issue number1
Early online date23 Oct 2018
DOIs
Publication statusPublished - 1 Jan 2020
Externally publishedYes

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.

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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