Comparison of CTA- and DSA-Based Collateral Flow Assessment in Patients with Anterior Circulation Stroke

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Fig 1.
Examples of DSA- and CTA-based collateral scores in 3 different patients. Images were selected by a maximum amount of contrast in the middle cerebral artery for CTA and adequate opacity in the venous phase for DSA. In the left column, the CTA image is shown (A1–C1); in the middle column, the anteroposterior DSA (A2–C2); and in the right column, the lateral DSA (A3–C3). A1–A3, Patient A with a right-sided M1 occlusion, which DSA assessed as grade 3, and CTA, as grade 3. B1–B3, Patient B with a left-sided M1 occlusion, which DSA assessed as grade 1, and CTA, as grade 3. C1–C3, Patient C with a left-sided M1 occlusion, which DSA assessed as grade 3 collateral flow, and CTA, as grade 1.
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Fig 2.
Distribution of CTA- and DSA-based collateral grades on the modified Rankin Scale. For CTA-based collateral grades, a clear change in distribution can be seen toward better clinical outcome for higher collateral grades. For DSA-based collateral grades, there is no change in distribution on mRS for higher collateral grades.

Table 1:

Patient characteristics^{^a}

Baseline Characteristic	Value
Patients	45
Median age (range) (yr)	63 (44–85)
Sex ratio (M/F)	22/23
Stroke side (L/R)	22/23
DSA occlusion site	M1 (n = 35), M2 (n = 10)
Clot migration (CTA to DSA)	ICA-T to M1 (n = 1)
	M1 to M2 (n = 6)
	M2 to M1 (n = 1)
IVT (yes/no)	36/9
Median NIHSS at baseline (range)	16 (6–30)
Median time onset to CTA (range) (min)	204 (21–496)
Median time onset to DSA (range) (min)	260 (108–390)

Note:—ICA-T indicates ICA terminus; IVT, intravenous thrombolysis. R, right; L, left.
↵a Range is displayed in parentheses. IVT displays if patients received IVT prior to IAT. Time to CTA and time to DSA represent the median time in minutes from symptom onset to the acquisition of CTA and DSA scans, respectively.