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Updated: Mar 28, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Comparison of four different collateral scores in acute ischemic stroke by CT angiography
Fatih Seker1, Arne Potreck1, Markus Möhlenbruch1
1Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
Insights
The American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) and Alberta Stroke Program Early CT Score (ASPECTS) collateral scores effectively assess acute ischemic stroke, correlating well with infarct core and mismatch. Other scores showed weaker correlations.
Area of Science:
- Neuroradiology
- Neurology
- Medical Imaging
Background:
- Accurate assessment of collateral circulation is crucial in acute ischemic stroke management.
- CT angiography (CTA) is widely used, but a gold standard collateral scoring system is lacking.
- Several scoring systems exist, but their comparative performance in CTA needs further evaluation.
Purpose of the Study:
- To compare the performance of four frequently used collateral scores in CT angiography (CTA).
- To evaluate the correlation of these scores with early infarct core and mismatch ratio in acute ischemic stroke patients.
- To determine the most reliable CTA-based collateral scoring system for clinical use.
Main Methods:
- Retrospective review of 30 acute ischemic stroke patients with M1 segment or terminal carotid artery occlusion.
- Collateral assessment using dynamic and single-phase CTA with ASITN/SIR, ASPECTS, Christoforidis, and Miteff scores.
- Spearman correlation analysis comparing collateral scores with early infarct core and mismatch ratio derived from RAPID software.
Main Results:
- ASITN/SIR and ASPECTS collateral scores demonstrated strong correlations with early infarct core (rho=-0.696, p<0.001 and rho=-0.677, p<0.001) and mismatch ratio (rho=0.609, p<0.001 and rho=0.581, p<0.001).
- Christoforidis and Miteff scores showed weaker correlations with infarct core and mismatch ratio (p>0.05 for all comparisons).
- ASITN/SIR and ASPECTS scores exhibited excellent inter-correlation (rho=0.901, p<0.001).
Conclusions:
- Modified ASITN/SIR and ASPECTS collateral scores are superior to Christoforidis and Miteff scores for assessing collateral status in acute ischemic stroke via CTA.
- These validated scores correlate better with infarct core and mismatch volume, likely due to evaluating vascular enhancement extent and delay.
- ASITN/SIR and ASPECTS provide reliable collateral assessment, aiding in clinical decision-making for stroke treatment.
Purpose:
Multiple scores have been described for the assessment of collateralization in acute ischemic stroke. Currently, there is no gold standard for collateral assessment by CT angiography (CTA). This study compared four frequently used collateral scores with regard to their correlation with early infarct core and mismatch ratio.
Methods:
30 consecutive patients with acute occlusion of the M1 segment or terminal carotid artery were reviewed retrospectively. Collaterals were assessed using dynamic and also single-phase CTA according to grading systems by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR), Alberta Stroke Program Early CT Score (ASPECTS) (on collaterals), Christoforidis et al and Miteff et al. The Christoforidis and ASITN/SIR scores, which were initially designed for conventional angiography, were adapted to be applicable to CTA. The scores were compared with respect to early infarct core and mismatch ratio in perfusion CT estimated by RAPID software using Spearman correlation.
Results:
ASITN/SIR and ASPECTS collateral scores showed good correlation with early infarct core (rho=-0.696, p<0.001 and rho=-0.677, p<0.001) and mismatch ratio (rho=0.609, p<0.001 and rho=0.581, p<0.001). In contrast, the Christoforidis and Miteff scores correlated less well with infarct core (rho=0.245, p=0.191 and rho=-0.272, p=0.145, respectively) and mismatch ratio (rho=-0.329, p=0.075 and rho=0.279, p=0.135, respectively). ASPECTS and ASITN/SIR showed excellent cross-correlation (rho=0.901, p<0.001).
Conclusions:
Compared with the Christoforidis and Miteff scores, the modified ASITN/SIR and ASPECTS collateral scores showed consistently higher correlation with the extent of early infarct core and mismatch volume. This is probably because these scores evaluate the extent and delay of vascular enhancement in the affected territory rather than the backflow of contrast medium to the occlusion.
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