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Updated: Mar 23, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Assessment of Collateral Status by Dynamic CT Angiography in Acute MCA Stroke: Timing of Acquisition and Relationship
I R van den Wijngaard1, G Holswilder2, M J H Wermer3
1From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.) Department of Neurology (I.R.v.d.W., J.B.), Medical Center Haaglanden, the Hague, the Netherlands wijngaardido@gmail.com.
Insights
Dynamic CT angiography (CTA) better assesses collateral blood flow in acute ischemic stroke patients than single-phase CTA. Extent of collateral flow, not speed, is key to determining infarct volume and patient outcomes.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Acute ischemic stroke necessitates rapid assessment of cerebral blood flow.
- Collateral circulation plays a critical role in determining infarct progression.
- Dynamic CT angiography (CTA) offers advanced visualization of collateral pathways.
Purpose of the Study:
- To evaluate collateral filling using dynamic CTA in acute ischemic stroke patients.
- To correlate dynamic CTA findings with follow-up infarct volume.
- To compare dynamic CTA with single-phase CTA for collateral assessment.
Main Methods:
- Patients with acute ischemic stroke due to proximal MCA occlusion were included.
- Dynamic CTA and single-phase CTA were performed within 9 hours of stroke onset.
- Collateral status was assessed, and its association with infarct volume (≥70 mL) was analyzed.
Main Results:
- Dynamic CTA showed a stronger association between poor collateral status and larger infarct volumes (≥70 mL) compared to single-phase CTA.
- The extent of collateral filling was more critical than the velocity of filling.
- Good-but-slow collaterals showed a similar risk ratio for poor outcome as good-and-fast collaterals.
Conclusions:
- Dynamic CTA provides a superior assessment of collateral circulation in acute ischemic stroke.
- The extent of collateral flow is a more significant predictor of infarct volume than flow velocity.
- Optimal timing of dynamic CTA acquisition is crucial for accurate collateral assessment.
Background And Purpose:
Dynamic CTA is a promising technique for visualization of collateral filling in patients with acute ischemic stroke. Our aim was to describe collateral filling with dynamic CTA and assess the relationship with infarct volume at follow-up.
Materials And Methods:
We selected patients with acute ischemic stroke due to proximal MCA occlusion. Patients underwent NCCT, single-phase CTA, and whole-brain CT perfusion/dynamic CTA within 9 hours after stroke onset. For each patient, a detailed assessment of the extent and velocity of arterial filling was obtained. Poor radiologic outcome was defined as an infarct volume of ≥70 mL. The association between collateral score and follow-up infarct volume was analyzed with Poisson regression.
Results:
Sixty-one patients with a mean age of 67 years were included. For all patients combined, the interval that contained the peak of arterial filling in both hemispheres was between 11 and 21 seconds after ICA contrast entry. Poor collateral status as assessed with dynamic CTA was more strongly associated with infarct volume of ≥70 mL (risk ratio, 1.9; 95% CI, 1.3-2.9) than with single-phase CTA (risk ratio, 1.4; 95% CI, 0.8-2.5). Four subgroups (good-versus-poor and fast-versus-slow collaterals) were analyzed separately; the results showed that compared with good and fast collaterals, a similar risk ratio was found for patients with good-but-slow collaterals (risk ratio, 1.3; 95% CI, 0.7-2.4).
Conclusions:
Dynamic CTA provides a more detailed assessment of collaterals than single-phase CTA and has a stronger relationship with infarct volume at follow-up. The extent of collateral flow is more important in determining tissue fate than the velocity of collateral filling. The timing of dynamic CTA acquisition in relation to intravenous contrast administration is critical for the optimal assessment of the extent of collaterals.
