Single- and Multiphase CT Angiography Is Associated With Digital Subtraction Angiography Collateral Score ≥3

Tara Srinivas; Dhairya A Lakhani; Aneri B Balar; Risheng Xu; Jee Moon; Caline Azzi; Nathan Hyson; Mona Shahriari; Sijin Wen; Cynthia Greene; Janet Mei; Farzad Maroufi; Jeremy J Heit; Tobias D Faizy; Gregory W Albers; Hamza Salim; Meisam Hoseinyazdi; Vivek S Yedavalli

doi:10.1111/jon.70048

Single- and Multiphase CT Angiography Is Associated With Digital Subtraction Angiography Collateral Score ≥3

J Neuroimaging. 2025 May-Jun;35(3):e70048. doi: 10.1111/jon.70048.

Authors

Tara Srinivas¹, Dhairya A Lakhani², Aneri B Balar², Risheng Xu^{1

3}, Jee Moon¹, Caline Azzi¹, Nathan Hyson¹, Mona Shahriari¹, Sijin Wen², Cynthia Greene¹, Janet Mei¹, Farzad Maroufi¹, Jeremy J Heit⁴, Tobias D Faizy⁵, Gregory W Albers⁶, Hamza Salim⁷, Meisam Hoseinyazdi¹, Vivek S Yedavalli¹

Affiliations

¹ Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA.
² Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA.
³ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁴ Department of Neuroimaging and Neurointervention, Stanford University, Stanford, California, USA.
⁵ Department of Radiology, University Hospitals Münster, Münster, Germany.
⁶ Department of Neurology, Stanford University, Stanford, California, USA.
⁷ Department of Neuroradiology, MD Anderson Cancer Center, Houston, Texas, USA.

PMID: 40369704
DOI: 10.1111/jon.70048

Abstract

Background and purpose: Collateral status is an important predictor of reperfusion and mortality in patients with large vessel anterior circulation acute ischemic stroke (AIS). We assess the utility of multiphase computed tomography angiography (CTA) derived from CT perfusion (CTP) source imaging (dCTA) in determining collateral status compared to the reference standard American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral score on digital subtraction angiography (DSA).

Methods: We retrospectively analyzed AIS patients treated at our institution from January 9, 2017, to January 10, 2023. Inclusion criteria included CTA-confirmed anterior circulation large vessel occlusion, diagnostic CTP, and mechanical thrombectomy with documented DSA collateral score. The modified treatment in cerebral ischemia score was used to assess reperfusion. Logistic regression analyses evaluated associations between demographic and clinical factors, collateral status, ASITN/SIR, and reperfusion status.

Results: A total of 311 patients (mean age 67.35 ± 16.37, 57.4% female) were included. Univariate analysis showed that proximal M2 (PM2) occlusion site (odds ratio [OR] 4.45, p < 0.001), Alberta Stroke Program Early CT Score (OR 1.24, p = 0.006), dCTA (OR 3.81, p < 0.001), and CTA Tan (OR 6.05, p < 0.001) were associated with an ASITN score of ≥3, indicating collateral flow. Multivariate regression, adjusted for race, occlusion site, radiologic features, National Institutes of Health stroke score, and premorbid modified Rankin score, found PM2 occlusion site (aOR 5.99, p < 0.001), dCTA (adjusted OR [aOR] 2.24, p = 0.04), and CTA Tan (aOR 3.71, p < 0.01) to be significant predictors of ASITN ≥3.

Conclusions: dCTA is associated with favorable DSA collateral scores and may aid clinical decision-making in AIS patients with large vessel occlusions. Further studies can assess its role in outcome prediction.

Keywords: CTA; collaterals; ischemic stroke; reperfusion.

MeSH terms

Aged
Aged, 80 and over
Angiography, Digital Subtraction* / methods
Cerebral Angiography* / methods
Collateral Circulation*
Computed Tomography Angiography* / methods
Female
Humans
Ischemic Stroke* / diagnostic imaging
Ischemic Stroke* / physiopathology
Male
Middle Aged
Retrospective Studies

Grants and funding

National Institute of General Medical Sciences of the National Institutes of Health