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Collateral circulation plays an important role in the clinical and radiological outcome after acute ischemic stroke. Several modalities are used to evaluate these alternative pathways with a growing interest in recent years. We conducted a literature review of studies evaluating collaterals at the acute phase of a carotid territory ischemic stroke. Most of them were based on conventional angiography and CT angiography, several on the basis of MRI and transcranial Doppler and, more recently, on the basis of dynamic CT angiography, which seems to be the most appropriate modality. Populations studied in these publications are often heterogeneous (especially concerning the occlusion site and the treatments performed) and many classifications have been proposed.

Summary Objectives This retrospective single-center study evaluated the technical success as well as the periprocedural and long-term complications of angioplasty with stenting of symptomatic intracranial atheromatous stenosis. Patients and methods From January 2005 to December 2010, 21 patients were treated by angioplasty with stent implantation for symptomatic atheromatous intracranial stenosis greater or equal to 50% at least 7 days after a stroke. Results The median population age was 65 years (range: 41–88 years), and 76% (16/21) of the candidates had a history of transient ischemic attack (TIA) or stroke before the event qualifying them for an endovascular procedure. In addition, 86% (18/21) were taking antithrombotic medication at the time of the qualifying event. Technical success was obtained in all cases. The periprocedural stroke or death rate was 9.5% (2/21), and there was no other stroke or death after 30 days during the mean follow-up of 1.4 years. Conclusion Endovascular treatment of symptomatic intracranial atherothrombotic stenosis can lead to severe complications, particularly during the periprocedural period, but it also represents the only alternative treatment for patients who fail with medical therapy. Future studies need to focus on improvement of periprocedural complications. Essentially, this should include more rigorous selection of candidates as well as a better understanding of the pathophysiological mechanism(s) of the ischemic phenomenon related to stenosis.