Chronic occlusion of major intracranial and extracranial arteries, including the internal carotid artery (ICA), vertebral artery (VA), and other large vessels, such as middle cerebral artery (MCA), is an important but under-characterized contributor to recurrent ischemic stroke, cognitive decline, and neurological disability. Despite its clinical relevance, the true burden of chronic large-vessel occlusion remains unclear, and treatment remains challenging due to heterogeneity in collateral circulation, underlying etiology (e.g., atherosclerosis, moyamoya disease), and variable response to medical or endovascular interventions.
This Research Topic aims to provide a comprehensive and mechanistic understanding of chronic large-vessel occlusive disease involving both the anterior and posterior cerebral circulation. We seek to highlight key developments in pathophysiology, prognostic biomarkers, advanced imaging techniques, and therapeutic strategies, including medical therapy, extracranial-to-intracranial bypass, and endovascular recanalization. A particular emphasis will be placed on the role of collateral circulation in influencing outcomes, and the growing recognition of cognitive impairment as a long-term consequence of chronic hypoperfusion.
We invite contributions that offer new insights into epidemiology, clinical presentation, imaging evaluation, therapeutic choice, and outcome prediction for patients with chronic intracranial or extracranial occlusions.
Suggested themes include, but are not limited to:
• Epidemiological and clinical studies of chronic large-vessel occlusion in ischemic cerebrovascular disease
• Imaging and functional assessment of collateral circulation and hemodynamic compromise
• Advances in diagnostic tools and neuroimaging (e.g., perfusion MRI, vessel wall imaging, functional imaging)
• Comparative effectiveness of pharmacological, surgical, and endovascular treatments
• Cognitive and neuropsychological sequelae of chronic cerebral hypoperfusion
• Mechanistic studies exploring molecular, inflammatory, or metabolic responses to chronic occlusion
• Occlusive disorders across different etiologies, including atherosclerosis, moyamoya disease, and inflammatory vasculopathies
We welcome original research articles, systematic reviews, clinical trial reports, and translational studies that contribute to a more precise understanding of chronic large-vessel occlusion and update clinical management strategies.
Keywords: chronic internal carotid artery occlusion, ischemic event, cognition, neuroimaging evaluation, recanalization strategy, prognosis
Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.
