Stroke, Vol 14, 332-341, Copyright © 1983 by American Heart Association
TS Olsen, B Larsen, M Herning, EB Skriver and NA Lassen
In a group of 48 patients with completed stroke, 8 patients had viable
collaterally perfused brain tissue which was accessible for rCBF recordings
with a two dimensional technique. All 8 had deep subcortical infarcts on
CT-scan, and angiographic occlusion of the arteries normally supplying the
infarcted territory. The brain tissue overlying the deep infarcts appeared
normal on CT-scan and was supplied by collateral circulation. rCBF was
measured in all within 72 hours after the stroke. The intra-carotid Xe-133
injection method and a 254 multidetector camera were used to study rCBF.
Relatively ischemic low flow areas were a constant finding in the
collaterally perfused tissue. In 6 of the patients, the collaterally
perfused part of the brain had low flow values comparable to those of an
"ischemic penumbra" (viable, but functionally depressed brain tissue due to
inadequate perfusion). Autoregulation was impaired in all of the
collaterally perfused areas while the CO2-response always was preserved.
Steal phenomena were not seen. In the surrounding brain tissue,
autoregulation was normal in 5 patients and impaired in 3 while the
CO2-response seemed to be normal. The results confirm the experimental
finding of an ischemic penumbra associated with acute cerebral infarcts and
suggest that early restoration of the blood flow in acute stroke patients
might improve recovery and prognosis in selected patients.
ARTICLES
Blood flow and vascular reactivity in collaterally perfused brain tissue. Evidence of an ischemic penumbra in patients with acute stroke
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