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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Cerebral collateralization and patterns of cerebral ischemia in patients with hemodynamic cerebrovascular compromise

Meeting Abstract

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  • Marcus Czabanka - Department of Neurosurgery, Universitätsmedizin Charité, Berlin, Deutschland
  • Daniel Jussen - Department of Neurosurgery, Universitätsmedizin Charité, Berlin, Deutschland
  • Tobias Finger - Department of Neurosurgery, Universitätsmedizin Charité, Berlin, Deutschland
  • Pablo Pena-Tapia - Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Deutschland
  • Gerrit A. Schubert - Department of Neurosurgery, University of Aachen, Deutschland
  • Peter Schmiedek - Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Deutschland
  • Peter Vajkoczy - Department of Neurosurgery, Universitätsmedizin Charité, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocDI.11.02

doi: 10.3205/14dgnc177, urn:nbn:de:0183-14dgnc1774

Published: May 13, 2014

© 2014 Czabanka et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Cerebral collateralization allows prediction and localisation in embolic stroke. In patients with hemodynamic compromise pathophysiology of stroke is unclear and the relevance of collateralization is unknown. It was the aim to characterize collateralization and ischemia patterns in patients with hemodynamic compromise.

Method: Hemodynamic compromise was verified using acetazolamide-stimulated Xenon-CT or SPECT in 54 patients (30 Moyamoya vasculopathy patients {MMV}, 24 patients with atherosclerotic cerebrovascular disease {ACVD}). All patients received MRI differentiating hemodynamic ischemia as anterior/posterior cortical borderzone infarction (CBI), inferior borderzone infarction (IBI) and/or territorial infarction (TI). Digital subtraction angiography was applied to evaluate collateralization. A disease specific collateralization score was used to differentiate between high and low collateralization patients. Collateralization was correlated with localisation of ischemia and number of vascular territories with impaired cerebrovascular reserve capacity (CVRC).

Results: MMV patients showed significantly more often collateralization via pericallosal anastomosis and extra-intracranial collaterals as ACVD patients (MMV: 95%/13% vs. ACVD: 23%/0%). ACVD patients demonstrated collateralization via the Acom and ophthalmic artery significantly more often than MMV patients (MMV: 6%/0% vs. ACVD: 62%/38%). Patterns of infarction were comparable (ant. CBI: MMV: 36%, ACVD: 35%; post. CBI: MMV: 10%, ACVD: 20%; IBI: MMV: 35%, ACVD: 41%; TI: MMV: 13%, ACVD: 18%). There was no difference in number or localisation of cerebral ischemia and in the number of impaired vascular territories between high and low collateralization patients.

Conclusions: Despite significant differences in collateralization, infarct patterns do not differ between MMV and ACVD patients. Cerebral collateralization does not allow conclusions about localization of cerebral ischemia or severity of impaired CVRC.