PT  - JOURNAL ARTICLE
AU  - I.G.H. Jansen
AU  - O.A. Berkhemer
AU  - A.J. Yoo
AU  - J.A. Vos
AU  - G.J. Lycklama à Nijeholt
AU  - M.E.S. Sprengers
AU  - W.H. van Zwam
AU  - W.J. Schonewille
AU  - J. Boiten
AU  - M.A.A. van Walderveen
AU  - R.J. van Oostenbrugge
AU  - A. van der Lugt
AU  - H.A. Marquering
AU  - C.B.L.M. Majoie
AU  - on behalf of the MR CLEAN investigators (www.mrclean-trial.org)
TI  - Comparison of CTA- and DSA-Based Collateral Flow Assessment in Patients with Anterior Circulation Stroke
AID  - 10.3174/ajnr.A4878
DP  - 2016 Nov 01
TA  - American Journal of Neuroradiology
PG  - 2037--2042
VI  - 37
IP  - 11
4099  - http://www.ajnr.org/content/37/11/2037.short
4100  - http://www.ajnr.org/content/37/11/2037.full
SO  - Am. J. Neuroradiol.2016 Nov 01; 37
AB  - BACKGROUND AND PURPOSE: Collateral flow is associated with clinical outcome after acute ischemic stroke and may serve as a parameter for patient selection for intra-arterial therapy. In clinical trials, DSA and CTA are 2 imaging modalities commonly used to assess collateral flow. We aimed to determine the agreement between collateral flow assessment on CTA and DSA and their respective associations with clinical outcome.MATERIALS AND METHODS: Patients randomized in MR CLEAN with middle cerebral artery occlusion and both baseline CTA images and complete DSA runs were included. Collateral flow on CTA and DSA was graded 0 (absent) to 3 (good). Quadratic weighted κ statistics determined agreement between both methods. The association of both modalities with mRS at 90 days was assessed. Also, association between the dichotomized collateral score and mRS 0–2 (functional independence) was ascertained.RESULTS: Of 45 patients with evaluable imaging data, collateral flow was graded on CTA as 0, 1, 2, 3 for 3, 10, 20, and 12 patients, respectively, and on DSA for 12, 17, 10, and 6 patients, respectively. The κ-value was 0.24 (95% CI, 0.16–0.32). The overall proportion of agreement was 24% (95% CI, 0.12–0.38). The adjusted odds ratio for favorable outcome on mRS was 2.27 and 1.29 for CTA and DSA, respectively. The relationship between the dichotomized collateral score and mRS 0–2 was significant for CTA (P = .01), but not for DSA (P = .77).CONCLUSIONS: Commonly applied collateral flow assessment on CTA and DSA showed large differences, indicating that these techniques are not interchangeable. CTA was significantly associated with mRS at 90 days, whereas DSA was not.CScollateral scoreIATintra-arterial therapyMR CLEANMulticenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands