Stroke therapy has entered a new era highlighted by the use of endovascular therapy in addition to intravenous thrombolysis. However, the efficacy of current therapeutic regimens might be reduced by their associated adverse events. For example, over-reperfusion and futile recanalization may lead to large infarct, brain swelling, hemorrhagic complication and neurological deterioration. The traditional pathophysiological understanding on ischemic stroke can hardly address these occurrences. Accumulating evidence suggests that a functional cerebral venous drainage, the major blood reservoir and drainage system in brain, may be as critical as arterial infusion for stroke evolution and clinical sequelae. Further exploration of the multi-faceted function of cerebral venous system may add new implications for stroke outcome prediction and future therapeutic decision-making. In this review, we emphasize the anatomical and functional characteristics of the cerebral venous system and illustrate its necessity in facilitating the arterial infusion and maintaining the cerebral perfusion in the pathological stroke content. We then summarize the recent critical clinical studies that underscore the associations between cerebral venous collateral and outcome of ischemic stroke with advanced imaging techniques. A novel three-level venous system classification is proposed to demonstrate the distinct characteristics of venous collaterals in the setting of ischemic stroke. Finally, we discuss the current directions for assessment of cerebral venous collaterals and provide future challenges and opportunities for therapeutic strategies in the light of these new concepts.

中风疗法进入了一个新时代，除静脉溶栓外，还采用了血管内疗法。然而，当前治疗方案的功效可能由于其相关的不良事件而降低。例如，过度再灌注和徒劳的再通气可能导致大面积梗塞，脑肿胀，出血并发症和神经系统恶化。关于缺血性中风的传统病理生理学理解几乎无法解决这些情况。越来越多的证据表明，功能性的脑静脉引流，脑部主要的血液贮存和引流系统可能与动脉输注一样对中风演变和临床后遗症同样重要。对脑静脉系统多方面功能的进一步探索可能为卒中结果预测和未来治疗决策提供新的含义。在这篇综述中，我们强调了脑静脉系统的解剖学和功能特征，并说明了其在促进动脉灌注和维持脑灌注的病理性卒中含量方面的必要性。然后，我们总结了最新的重要临床研究，这些研究强调了先进的成像技术在脑静脉侧支与缺血性卒中结局之间的关联。提出了一种新颖的三级静脉系统分类法，以证明在缺血性卒中中静脉侧支的独特特征。最后，