Roles and mechanisms of leptomeningeal collaterals in human distal MCA territory ischemia

Abstract

BackgroundLeptomeningeal collaterals (LMCs) provided hemodynamic support and reperfusion during acute ischemic stroke (AIS). Although regulation details have been deeply acquired from animal models, human cortex may share limited hemodynamic patterns due to larger physical scale that needs further investigation. MethodsWe performed sequential hierarchical blocking during awake craniotomy on fourteen human subjects to mimic AIS in middle cerebral artery (MCA) M4 segment territory. Widefield microscope was applied to reveal microcirculation of LMCs. Relative flow rate (RFR) was measured to evaluate the impact of LMCs hierarchy on microcirculation maintenance. Single-cell sequencing and spatial transcriptomics were further performed to analyze the mechanism of different LMCs recruitment abilities. ResultsLMCs RFR decreased to 30.75% immediately (95% CI, 6.64 - 54.86%, P View larger version (24K): org.highwire.dtl.DTLVardef@eb7fb8org.highwire.dtl.DTLVardef@10e10aforg.highwire.dtl.DTLVardef@6954c7org.highwire.dtl.DTLVardef@13ceb98_HPS_FORMAT_FIGEXP M_FIG C_FIG