Abstract
Objective: Ischemic stroke is a leading cause of death and disability. Autoregulation and collateral blood flow through the circle of Willis both play a role in preventing tissue infarction. A steady-state model of the cerebral arterial network was used to investigate the interaction of these mechanisms when autoregulation is impaired ipsilateral to an occluded artery.
Materials and methods: Twelve structural variants of the circle of Willis were modelled with left internal carotid artery occlusion and coupled with (1) a passive model of the cerebral vascular bed, (2) a steady-state model of an autoregulating cerebral vascular bed, and (3) a model in which the contralateral hemisphere autoregulates and the ipsilateral hemisphere does not.
Results: Results showed that if the autoregulatory response is impaired ipsilaterally, then, in the autoregulating hemisphere, cerebral flows are preserved at the expense of those on the ipsilateral side.
Conclusions: Thus, although autoregulation is an essential facilitator of collateral flow through the circle of Willis, contralateral autoregulation can exacerbate flow reductions if not balanced by the same response in the vascular beds on the ipsilateral side. The status of the autoregulatory response in both hemispheres can strongly influence cerebral blood flows and tissue survival and should, therefore, be monitored in stroke.
References
Markus H. Cerebral perfusion and stroke. J Neurol Neurosurg Psychiatry. 2004;75(3):353–61.
Liebeskind DS. Collateral circulation. Stroke. 2003;34(9):2279–84.
Alpers BJ, Berry RG, Paddison RM. Anatomical studies of the circle of Willis in normal brain. AMA Arch Neurol Psychiatry. 1959;81(4):409–18.
Riggs HE, Rupp C. Variation in form of circle of Willis: the relation of the variations to collateral circulation: anatomic analysis. Arch Neurol. 1963;8:8–14.
Papantchev V, Stoinova V, Aleksandrov A, Todorova-Papantcheva D, Hristov S, Petkov D, Nachev G, Ovtscharoff W. The role of Willis circle variations during unilateral selective cerebral perfusion: a study of 500 circles. Eur J Cardiothorac Surg. 2013;44(4):743–53.
Romero JR, Pikula A, Nguyen TN, Nien YL, Norbash A, Babikian VL. Cerebral collateral circulation in carotid artery disease. Curr Cardiol Rev. 2009;5(4):279–88.
Angermaier A, Langner S, Kirsch M, Kessler C, Hosten N, Khaw AV. CT-angiographic collateralization predicts final infarct volume after intra-arterial thrombolysis for acute anterior circulation ischemic stroke. Cerebrovasc Dis. 2011;31(2):177–84.
Bang OY, Saver JL, Kim SJ, Kim GM, Chung CS, Ovbiagele B, Lee KH, Liebeskind DS. Collateral flow predicts response to endovascular therapy for acute ischemic stroke. Stroke. 2011;42(3):693–9.
Bang OY, Saver JL, Kim SJ, Kim GM, Chung CS, Ovbiagele B, Lee KH, Liebeskind DS. Collateral flow averts hemorrhagic transformation after endovascular therapy for acute ischemic stroke. Stroke. 2011;42(8):2235–9.
Payne SJ. Cerebral autoregulation. SpringerBriefs in bioengineering. New York, NY: Springer; 2016.
Kennedy McConnell F, Payne SJ. The dual role of cerebral autoregulation and collateral flow in the circle of Willis after major vessel occlusion. IEEE Trans Biomed Eng. 2016;64(8):1793–802.
Alastruey J, Moore S, Parker K, David T, Peiró J, Sherwin S. Reduced modelling of blood flow in the cerebral circulation: coupling 1-D, 0-D and cerebral auto-regulation models. Int J Numer Meth Fl. 2008;56(8):1061–7.
Liang F, Fukasaku K, Liu H, Takagi S. A computational model study of the influence of the anatomy of the circle of willis on cerebral hyperperfusion following carotid artery surgery. Biomed Eng Online. 2011;10:84.
AcknowledgementsFKM
gratefully acknowledges support from Research Councils UK Digital Economy Programme: Grant EP/G036861/1 (Oxford Centre for Doctoral Training in Healthcare Innovation).
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Kennedy McConnell, F.A., Payne, S.J. (2018). Autoregulating Cerebral Tissue Selfishly Exploits Collateral Flow Routes Through the Circle of Willis. In: Heldt, T. (eds) Intracranial Pressure & Neuromonitoring XVI. Acta Neurochirurgica Supplement, vol 126. Springer, Cham. https://doi.org/10.1007/978-3-319-65798-1_54
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DOI: https://doi.org/10.1007/978-3-319-65798-1_54
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