Page 53 - Inaugural Lecture Prof Dr Ahmad Sobri Muda

Ahmad Sobri Muda

A non-invasive diagnostic procedure for evaluating collateral
vasculature is only possible with the availability of cutting-edge
imaging technologies such as CTA and MRI. They provide fast
evaluation of the vascular network architecture and the site of
the blockage in acute stroke. More detailed collaterals evaluation
is done in some institutions with minimally invasive diagnostic
cerebral angiography utilizing CBCT (VasoCT; Philips), which
provides a more comprehensive cerebral vascular networks
assessment. Cone beam computed tomography (CBCT), a cutting-
edge imaging technology, produces more detailed and accurate
three-dimensional (3D) pictures of bone, soft tissue, and contrast-
filled smaller vascular networks. Due to its advantages over regular
CT, CBCT is being utilised more commonly in acute stroke and
neurointerventional treatments, especially to assess neurovascular
abnormalities for patient selection and treatment planning. The
higher spatial resolution of CBCT compared to conventional CT
angiography allows it to show smaller contrasted vessels with fewer
artifacts.
Endovascular treatment of acute ischemic stroke could be
enhanced using good collateral circulation and reduced risk of
hemorrhagic transformation. Therefore, any strategy to promote
new collateral blood flow is necessary during brain ischemia to
increase collateral blood flow. A crucial aspect of treating ischemic
stroke is extending the therapeutic time window following ischemia
and increasing collateral blood flow perfusion.
When pressure gradients arise, pre-existing communication
routes are used. In cases with occlusion of intracranial segment
ICA or extracranial internal carotid artery (ICA) occlusions and
high-grade stenosis, it has been demonstrated that anastomoses that
can circumvent the blockage along the reversed ophthalmic artery
to the carotid artery can be formed. In the event of total occlusion,

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