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Case report: Flow changes in routes of collateral circulation in patients with LVO and low NIHSS: a point favor to treat

  • Santos Neto, Elizeu Pereira dos1, 2
  • de Sousa, Ícaro Araújo3
  • Veras, Arthur de Oliveira3
  • Barros-Araújo, Marx Lima de1
  • Ricarte, Irapuá Ferreira4
  • Pontes-Neto, Octávio Marques3
  • 1 Institute of Radiology, University of São Paulo School of Medicine, Hospital das Clínicas, São Paulo, SP , (Brazil)
  • 2 Neurologist and Interventional Neuroradiologist, Hospital Santa Maria, Teresina, PI , (Brazil)
  • 3 Department of Neuroscience and Behavior Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP , (Brazil)
  • 4 Department of Neurology and Neurosurgery, São Paulo Federal University, São Paulo, SP , (Brazil)
Published Article
Frontiers in Neurology
Frontiers Media SA
Publication Date
Jun 08, 2023
DOI: 10.3389/fneur.2023.1165484
  • Neurology
  • Case Report


The effectiveness of endovascular thrombectomy in patients presenting low National Institutes of Health Stroke Scale (NIHSS) scores remains controversial, and the acquisition of additional evidence is required to refine the selection of candidates who may benefit the most from this therapeutic modality. In this study, we present the case of a 62-year-old individual, with left internal carotid occlusion stroke and low NIHSS, who had compensatory collateral flow from Willis polygon via the anterior communicating artery. The patient subsequently exhibited neurological deterioration and collateral flow failure from Willis polygon, indicating the need for urgent intervention. The study of collaterals in patients with large vessel occlusion stroke has garnered considerable attention, with research suggesting that individuals with low NIHSS scores and poor collateral profiles may be at a heightened risk of early neurological deterioration. We postulate that such patients may derive significant benefits from endovascular thrombectomy, and may posit that an intensive transcranial Doppler monitoring protocol could facilitate the identification of suitable candidates for such intervention.

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