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The familiar phrase “time is brain” may be more correctly rephrased “time and penumbra are brain” because several clinical trials have demonstrated that IV alteplase and endovascular thrombectomy treatment windows can be extended when patients have favorable diffusion-perfusion mismatch profiles.1-3 Collateral circulation protects the brain by minimizing and preventing expansion of the ischemic core.4 Favorable collaterals have been associated with better recanalization rates, radiographic outcomes, and patient outcomes.4 Several collateral grading systems and assessments are available and rely on imaging techniques that can directly visualize collaterals such as catheter angiography, magnetic resonance angiography, and CT angiography or perfusion techniques that may indirectly provide information about the robustness of collateral circulation.4 Collateral grading systems have not been validated in cohorts of children with stroke.
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.
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