Collateral Scores in Acute Ischemic Stroke
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Background and Purpose
Several collateral scores have been published for stroke in the middle cerebral artery territory, each considering different aspects of cerebral collateralization. Currently, there is no gold standard in CT-based collateral assessment. The aim of this retrospective study was to compare five collateral scores and determine whether they are able to predict clinical outcome after thrombectomy as standalone parameters.
Inclusion criteria were M1 occlusion, premorbid modified Rankin scale (mRS) of 0–3, treatment with endovascular thrombectomy and groin puncture within 12 h after stroke onset. The Maas et al., Miteff et al., Tan et al., ASITN/SIR and mCTA collateral scores were retrospectively assessed in multiphase CTA images and correlated with 90-day mRS (90d-mRS) scores. Good outcome was defined as 90d-mRS 0–2 or unchanged to premorbid mRS.
In total, 108 patients were included of which 39.8% achieved a good outcome. The area under the curve (AUC) values of receiver operating characteristic (ROC) curve analysis for Maas et al., Miteff et al., Tan et al., ASITN/SIR and mCTA scores were 0.60 (0.51–0.70), 0.60 (0.52–0.68), 0.61 (0.51–0.70), 0.59 (0.49–0.70) and 0.61 (0.50–0.71), respectively. The correlation between 90d-mRS and Maas (r = −0.16, P = 0.091), Miteff (r = −0.25, P = 0.009), Tan (r = −0.26, P = 0.007), ASITN/SIR (r = −0.21, P = 0.030) and mCTA (r = −0.22, P = 0.021) scores was poor.
Although collaterals are known to correlate with clinical outcome, none of the analyzed collateral scores sufficiently predicted outcome as a standalone parameter.
KeywordsMaas Miteff Tan ASITN/SIR mCTA
Modified Rankin scale score at 90 days
American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology
Area under the curve
Multiphase computed tomography angiography
Receiver operating characteristic
F. Seker, M. Bendszus and M.A. Möhlenbruch conceived the study and initiated the study design. F. Seker, B. Pereira-Zimmermann, J. Pfaff, J. Purrucker, C. Gumbinger and S. Schönenberger contributed to acquisition of data for the work. F. Seker, B. Pereira-Zimmermann, M. Bendszus and M.A. Möhlenbruch contributed to analysis and interpretation of data. All authors contributed to refinement of the study protocol and reviewed and approved the final manuscript.
B. Pereira-Zimmermann received funding from the Ministry of Education and University of Valparaiso in Chile.
Compliance with ethical guidelines
Conflict of interest
F. Seker, J. Pfaff, J. Purrucker, C. Gumbinger, S. Schönenberger, M. Bendszus and M.A. Möhlenbruch declare that they have no competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards.