Abstract

Purpose: To prospectively investigate the extent of flow territories of the contralateral internal carotid artery (ICA) and vertebrobasilar arteries in patients with symptomatic ICA occlusion.

Materials and Methods: Ethics committee approval and informed consent were obtained. Flow territory mapping of the ICA contralateral to the occluded ICA and mapping of the vertebrobasilar arteries were performed by using selective arterial spin-labeling magnetic resonance imaging in 23 functionally independent patients (22 men, one woman; mean age, 58 years ± 8 [standard deviation]) with symptomatic ICA occlusion. The control group consisted of 68 subjects (57 men, 11 women; mean age, 59 years ± 9) without hemodynamically significant ICA obstruction. Voxel-based χ² testing with Bonferroni correction was performed to analyze significant differences in the extent of the flow territories.

Results: Flow territory maps in patients with symptomatic ICA occlusion showed significant differences in the flow territories of the contralateral ICA and vertebrobasilar arteries compared with those in control subjects (P < .05).

Conclusion: In functionally independent patients with symptomatic ICA occlusion, the middle cerebral artery flow territory ipsilateral to the occluded ICA is mainly supplied by the vertebrobasilar arteries, whereas the anterior cerebral artery flow territory on the occluded side is mainly supplied by the contralateral ICA.

References

1 Powers WJ. Cerebral hemodynamics in ischemic cerebrovascular disease. Ann Neurol 1991; 29: 231–240. Crossref, Medline, Google Scholar
2 Powers WJ, Press GA, Grubb RL Jr. The effect of hemodynamically significant carotid artery disease on the hemodynamic status of the cerebral circulation. Ann Intern Med 1987;106:27–35. Crossref, Medline, Google Scholar
3 Liebeskind DS. Collateral circulation. Stroke 2003;34:2279–2284. Crossref, Medline, Google Scholar
4 van Everdingen KJ, Klijn CJ, Kappelle LJ, Mali WP, van der Grond J. MRA flow quantification in patients with a symptomatic internal carotid artery occlusion. Stroke 1997;28:1595–1600. Crossref, Medline, Google Scholar
5 Henderson RD, Eliasziw M, Fox AJ, Rothwell PM, Barnett HJ. Angiographically defined collateral circulation and risk of stroke in patients with severe carotid artery stenosis. Stroke 2000;31:128–132. Crossref, Medline, Google Scholar
6 Vernieri F, Pasqualetti P, Matteis M, et al. Effect of collateral blood flow and cerebral vasomotor reactivity on the outcome of carotid artery occlusion. Stroke 2001;32:1552–1558. Crossref, Medline, Google Scholar
7 Jongen JC, Franke CL, Ramos LM, Wilmink JT, van Gijn J. Direction of flow in posterior communicating artery on magnetic resonance angiography in patients with occipital lobe infarcts. Stroke 2004;35:104–108. Crossref, Medline, Google Scholar
8 van Everdingen KJ, Visser GH, Klijn CJ, Kappelle LJ, van der Grond J. Role of collateral flow on cerebral hemodynamics in patients with unilateral internal carotid artery occlusion. Ann Neurol 1998;44:167–176. Crossref, Medline, Google Scholar
9 Rutgers DR, Klijn CJ, Kappelle LJ, van der Grond J. Recurrent stroke in patients with symptomatic carotid artery occlusion is associated with high-volume flow to the brain and increased collateral circulation. Stroke 2004;35:1345–1349. Crossref, Medline, Google Scholar
10 Klijn CJ, Kappelle LJ, van Huffelen AC, et al. Recurrent ischemia in symptomatic carotid occlusion: prognostic value of hemodynamic factors. Neurology 2000;55:1806–1812. Crossref, Medline, Google Scholar
11 Yamauchi H, Kudoh T, Sugimoto K, Takahashi M, Kishibe Y, Okazawa H. Pattern of collaterals, type of infarcts, and haemodynamic impairment in carotid artery occlusion. J Neurol Neurosurg Psychiatry 2004;75:1697–1701. Crossref, Medline, Google Scholar
12 Hendrikse J, van der Grond J, Lu H, van Zijl PC, Golay X. Flow territory mapping of the cerebral arteries with regional perfusion MRI. Stroke 2004;35:882–887. Crossref, Medline, Google Scholar
13 Bamford JM, Sandercock PA, Warlow CP, Slattery J. Interobserver agreement for the assessment of handicap in stroke patients [letter]. Stroke 1989;20:828. Google Scholar
14 Fox AJ. How to measure carotid stenosis. Radiology 1993;186:316–318. Link, Google Scholar
15 Rutgers DR, Klijn CJ, Kappelle LJ, van Huffelen AC, van der Grond J. A longitudinal study of collateral flow patterns in the circle of Willis and the ophthalmic artery in patients with a symptomatic internal carotid artery occlusion. Stroke 2000;31:1913–1920. Crossref, Medline, Google Scholar
16 Hendrikse J, Hartkamp MJ, Hillen B, Mali WP, van der Grond J. Collateral ability of the circle of Willis in patients with unilateral internal carotid artery occlusion: border zone infarcts and clinical symptoms. Stroke 2001;32:2768–2763. Crossref, Medline, Google Scholar
17 Golay X, Stuber M, Pruessmann KP, Meier D, Boesiger P. Transfer insensitive labeling technique (TILT): application to multislice functional perfusion imaging. J Magn Reson Imaging 1999;9:454–461. Crossref, Medline, Google Scholar
18 Calamante F, Thomas DL, Pell GS, Wiersma J, Turner R. Measuring cerebral blood flow using magnetic resonance imaging techniques. J Cereb Blood Flow Metab 1999;19:701–735. Crossref, Medline, Google Scholar
19 Barbier EL, Lamalle L, Decorps M. Methodology of brain perfusion imaging. J Magn Reson Imaging 2001;13:496–520. Crossref, Medline, Google Scholar
20 Pruessmann KP, Golay X, Stuber M, Scheidegger MB, Boesiger P. RF pulse concatenation for spatially selective inversion. J Magn Reson 2000;146:58–65. Crossref, Medline, Google Scholar
21 Ashburner J, Friston KJ. Voxel-based morphometry: the methods. Neuroimage 2000;11:805–821. Crossref, Medline, Google Scholar
22 Mazziotta JC, Toga AW, Evans A, Fox P, Lancaster J. A probabilistic atlas of the human brain: theory and rationale for its development—the International Consortium for Brain Mapping (ICBM). Neuroimage 1995;2:89–101. Crossref, Medline, Google Scholar
23 van der Zwan A, Hillen B, Tulleken CA, Dujovny M. A quantitative investigation of the variability of the major cerebral arterial territories. Stroke 1993;24:1951–1959. Crossref, Medline, Google Scholar
24 van der Zwan A, Hillen B, Tulleken CA, Dujovny M, Dragovic L. Variability of the territories of the major cerebral arteries. J Neurosurg 1992;77:927–940. Crossref, Medline, Google Scholar
25 Hoksbergen AW, Majoie CB, Hulsmans FJ, Legemate DA. Assessment of the collateral function of the circle of Willis: three-dimensional time-of-flight MR angiography compared with transcranial color-coded duplex sonography. AJNR Am J Neuroradiol 2003;24:456–462. Medline, Google Scholar
26 Lopez-Bresnahan MV, Kearse LA Jr, Yanez P, Young TI. Anterior communicating artery collateral flow protection against ischemic change during carotid endarterectomy. J Neurosurg 1993;79:379–382. Crossref, Medline, Google Scholar
27 Kluytmans M, van der Grond J, van Everdingen KJ, Klijn CJ, Kappelle LJ, Viergever MA. Cerebral hemodynamics in relation to patterns of collateral flow. Stroke 1999;30:1432–1439. Crossref, Medline, Google Scholar
28 Cassot F, Vergeur V, Bossuet P, Hillen B, Zagzoule M, Marc-Vergnes JP. Effects of anterior communicating artery diameter on cerebral hemodynamics in internal carotid artery disease: a model study. Circulation 1995;92:3122–3131. Crossref, Medline, Google Scholar
29 Miralles M, Dolz JL, Cotillas J, et al. The role of the circle of Willis in carotid occlusion: assessment with phase contrast MR angiography and transcranial duplex. Eur J Vasc Endovasc Surg 1995;10:424–430. Crossref, Medline, Google Scholar
30 Battacharji SK, Hutchinson EC, McCall AJ. The circle of Willis: the incidence of developmental abnormalities in normal and infarcted brains. Brain 1967;90:747–758. Crossref, Medline, Google Scholar
31 Schomer DF, Marks MP, Steinberg GK, et al. The anatomy of the posterior communicating artery as a risk factor for ischemic cerebral infarction. N Engl J Med 1994;330:1565–1570. Crossref, Medline, Google Scholar
32 Lee JH, Choi CG, Kim do K, Kim GE, Lee HK, Suh DC. Relationship between circle of Willis morphology on 3D time-of-flight MR angiograms and transient ischemia during vascular clamping of the internal carotid artery during carotid endarterectomy. AJNR Am J Neuroradiol 2004;25:558–564. Medline, Google Scholar
33 Muller M, Hermes M, Bruckmann H, Schimrigk K. Transcranial Doppler ultrasound in the evaluation of collateral blood flow in patients with internal carotid artery occlusion: correlation with cerebral angiography. AJNR Am J Neuroradiol 1995;16:195–202. Medline, Google Scholar
34 Brozici M, van der Zwan A, Hillen B. Anatomy and functionality of leptomeningeal anastomoses: a review. Stroke 2003;34:2750–2762. Crossref, Medline, Google Scholar
35 Hendrikse J, van Osch MJ, Rutgers DR, et al. Internal carotid artery occlusion assessed at pulsed arterial spin-labeling perfusion MR imaging at multiple delay times. Radiology 2004;233:899–904. Link, Google Scholar

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Published in print: 2007

Vol. 242, No. 2

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