Collateral Scores in Acute Ischemic Stroke

A retrospective study assessing the suitability of collateral scores as standalone predictors of clinical outcome
  • Fatih Seker
  • Benjamin Pereira-Zimmermann
  • Johannes Pfaff
  • Jan Purrucker
  • Christoph Gumbinger
  • Silvia Schönenberger
  • Martin Bendszus
  • Markus A. MöhlenbruchEmail author
Original Article


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.


Maas 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


Interquartile range


Multiphase computed tomography angiography


Receiver operating characteristic


Author Contribution

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.

Ethical standards

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.

Supplementary material

62_2019_858_MOESM1_ESM.docx (11 kb)
Figure 1. Box plots demonstrating 90 day modified Rankin Scale (90d-mRS) scores for every score point on Maas, Miteff, Tan, ASITN/SIR and mCTA collateral scores.
62_2019_858_MOESM2_ESM.tiff (253 kb)
Tables 1–5 are describing Maas, Miteff, Tan, ASITN/SIR and mCTA collateral scores.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Fatih Seker
    • 1
  • Benjamin Pereira-Zimmermann
    • 2
  • Johannes Pfaff
    • 1
  • Jan Purrucker
    • 3
  • Christoph Gumbinger
    • 3
  • Silvia Schönenberger
    • 3
  • Martin Bendszus
    • 1
  • Markus A. Möhlenbruch
    • 1
    Email author
  1. 1.Department of NeuroradiologyHeidelberg University HospitalHeidelbergGermany
  2. 2.Department of RadiologyUniversity of ValparaisoValparaisoChile
  3. 3.Department of NeurologyHeidelberg University HospitalHeidelbergGermany

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