Comparison of CTA- and DSA-Based Collateral Flow Assessment in Patients with Anterior Circulation Stroke

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The authors set out to determine the agreement between collateral flow assessment on CTA and DSA and their respective associations with clinical outcome. They used patient data that was randomized in MR CLEAN with middle cerebral artery occlusion and both baseline CTA images and complete DSA runs. Collateral flow on CTA and DSA was graded 0 (absent) to 3 (good).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 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, but not for DSA. They conclude that the commonly applied collateral flow assessment on CTA and DSA showed large differences and that these techniques are not interchangeable. CTA was significantly associated with mRS at 90 days, whereas DSA was not.

Abstract

Figure 1 from paper
Examples of DSA- and CTA-based collateral scores in 3 different patients. Images were selected by a maximum amount of contrast in the middle cerebral artery for CTA and adequate opacity in the venous phase for DSA. In the left column, the CTA image is shown (A1–C1); in the middle column, the anteroposterior DSA (A2–C2); and in the right column, the lateral DSA (A3–C3). A1–A3, Patient A with a right-sided M1 occlusion, which DSA assessed as grade 3, and CTA, as grade 3. B1–B3, Patient B with a left-sided M1 occlusion, which DSA assessed as grade 1, and CTA, as grade 3. C1–C3, Patient C with a left-sided M1 occlusion, which DSA assessed as grade 3 collateral flow, and CTA, as grade 1.

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.

 

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Comparison of CTA- and DSA-Based Collateral Flow Assessment in Patients with Anterior Circulation Stroke
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Jeffrey Ross
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