Introduction: The leptomeningeal collaterals are a subsidiary network of vascular channels that act as anastomotic channels in conditions where cerebral blood flow is pathologically altered. These secondary collateral pathways may be utilized when collateral flow through the circle of Willis is inadequate.
Summary of review: The review highlights the importance of leptomeningeal (pial) anastomoses in the brain especially in conditions of hemodynamic impairment such as ischemic stroke. The historical perspective regarding the role of these vessels is discussed. New advancements in the diagnostic and treatment modalities for the evaluation and optimization of these vessels are identified.
Conclusion: Evaluation and optimization of the leptomeningeal collaterals in ischemic stroke represents an important venue in prevention and treatment of cerebral ischemia.
Keywords: cerebral blood flow; ischemic stroke; leptomeningeal collaterals.