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. 2017 Jul 3;8:317. doi: 10.3389/fneur.2017.00317

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Copyright © 2017 Regenhardt, Das, Stapleton, Chandra, Rabinov, Patel, Hirsch and Leslie-Mazwi.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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AP angiographic images demonstrating adaptations of poorly perfused cerebral tissue, right internal carotid injection. Right middle cerebral artery (MCA) stroke, demonstrating poorly perfused but viable penumbral tissue as a therapeutic target through elevation of blood pressure. (A) Mid arterial phase. Black arrow: complete occlusion of MCA superior division. White arrow: partial occlusion of MCA inferior division. Dotted line: watershed zone between anterior and middle cerebral arteries. Small caliber vessels in this region represent leptomeningeal collaterals. Note early retrograde filling of distal superior division MCA territory (dotted arrow). (B) Late arterial phase. Black arrow heads demonstrate delayed antegrade fill of the inferior division and delayed retrograde fill of the superior division MCA branches. Note the maximal dilatation of these vessels, and the delay to parenchymal opacification when compared to the normally perfused anterior cerebral artery territory (white arrow heads). Both the partial occlusion with antegrade flow and the complete occlusion with retrograde collateral support benefit from systemic hypertensive responses, given the pressure passivity of the dilated distal MCA vasculature.