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Diagnostic test accuracy of pretreatment collateral score in predicting stroke outcomes after intra-arterial endovascular thrombectomy: a meta-analysis in DSA and CTA



This study compared the diagnostic accuracy of pretreatment circulation collateral scoring (CS) system using digital subtraction angiography (DSA) and computed tomography angiography (CTA) in predicting favorable functional outcome (FFO) after intra-arterial endovascular thrombectomy (IA-EVT). Subgroup analysis characterizing scoring systems within each category was additionally conducted.

Materials and methods

We performed a diagnostic meta-analysis to assess the sensitivity and specificity of each CS system by using DSA and CTA, respectively. The hierarchical summary receiver operating characteristic curve (HSROC) models were used to estimate the diagnostic odds ratio (DOR) and area under the curve (AUC). The Bayes theorem was employed to determine posttest probability (PTP).


In total, 14 and 21 studies were assessed with DSA and CTA, respectively. In DSA, the pooled sensitivity and specificity were 0.72 (95% CI, 0.63–0.79) and 0.61 (0.53–0.68), respectively, and in the HSROC model, the DOR was 3.94 (2.71–5.73), and the AUC was 0.71 (90.67–0.75). CTA revealed a pooled sensitivity and specificity of 0.74 (0.64–0.82) and 0.53 (0.44–0.62), respectively, and in the HSROC model, the DOR was 3.17 (2.34–4.50), and the AUC was 0.67 (0.63–0.71). With a pretest probability of 26.3%, the CS in DSA and CTA exhibited limited increase of PTPs of 39% and 36%, respectively, in detecting the FFO on day 90.


DSA and CTA have comparable accuracy and are limited in predicting the functional outcome. The collateral score systems assessed with DSA and CTA were more suitable for screening than diagnosis for patients before IA-EVT.

Key Points

Our study revealed the differences of various scoring systems for assessing collateral status.

DSA and CTA have comparable accuracy, but both imaging modalities played relatively limited roles in predicting functional outcome on day 90.

The collateral score systems assessed with DSA and CTA were more suitable for screening than diagnosis for patients before IA-EVT.

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American Society of Intervention and Therapeutic Neuroradiology/Society of Interventional Radiology


Area under the curve


Collateral scoring


Computed tomography angiography


Diagnostic odds ratio


Digital subtraction angiography


Favorable functional outcome


Hierarchical summary receiver operating characteristic curve


Intra-arterial endovascular thrombectomy


Modified Rankin Scale


Posttest probability


Regional leptomeningeal collateral


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Data curation and investigation were performed by Wei-Zhen Lu, Hui-An Lin, Chyi-Huey Bai, Sen-Kuang Hou, and Sheng-Feng Lin. Wei-Zhen Lu (first author) and Hui-An Lin (co-first author) contributed equally. Formal analysis and software were conducted by Sheng-Feng Lin. Original draft was wrote by Wei-Zhen Lu, Hui-An Lin, and Sheng-Feng Lin. Final review and editing of the draft were performed by Wei-Zhen Lu and Sheng-Feng Lin.


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The scientific guarantor of this publication is Sheng-Feng Lin.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors, Sheng-Feng Lin, has significant statistical expertise.

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This study was a systemic review and meta-analysis. No informed consent and ethical committee review were required. This study was registered on PROSPERO (reference number: CRD42021237879).

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This study was registered on PROSPERO (reference number: CRD42021237879). This study was a systemic review and meta-analysis. No informed consent and ethical committee review were required.


  • Retrospective

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  • Multicentre study

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Wei-Zhen Lu is the first author, and Hui-An Lin is the co-first author.

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Lu, WZ., Lin, HA., Hou, SK. et al. Diagnostic test accuracy of pretreatment collateral score in predicting stroke outcomes after intra-arterial endovascular thrombectomy: a meta-analysis in DSA and CTA . Eur Radiol 32, 6097–6107 (2022).

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  • Acute ischemic stroke
  • Collateral circulation
  • Computed tomography angiography
  • Digital subtraction angiography
  • Thrombectomy