Javed Anees: Cerebral Collateral Circulation in Ischemic Stroke
Javed Anees, Medical Consultant at Government of Kerala, shared a post on LinkedIn:
“Cerebral Collateral Circulation in Ischemic Stroke
Collateral circulation is one of the key determinants of tissue survival, infarct progression, treatment response, and functional outcome following acute ischemic stroke.
This infographic brings together the clinically relevant concepts of cerebral collateral physiology-from the Circle of Willis and leptomeningeal networks to pressure-gradient–driven recruitment, collateral assessment with DSA and multiphase CTA, perfusion imaging, and the core–penumbra relationship.
An important concept is the distinction between fast and slow infarct progressors.
Two patients with apparently similar arterial occlusions and onset times may have very different volumes of salvageable tissue because of differences in collateral support.
Modern stroke imaging therefore extends beyond simply identifying the occluded artery – it helps us understand how much brain remains viable and how rapidly it is being lost, particularly when considering reperfusion strategies.
Take-home message:
Time matters, but collateral physiology helps determine how tissue experiences that time.”

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