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Related Experiment Video

Updated: Jan 13, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Collateral Status Evaluation Using CT Angiography and Perfusion Source Images in Acute Stroke Patients.

Heitor C B R Alves1,2, Bruna G Dutra1,2, Vivian Gagliardi3

  • 1Department of Radiology and Oncology, Universidade de São Paulo, São Paulo 05508-060, SP, Brazil.

Brain Sciences
|October 29, 2025
PubMed
Summary

A new dynamic CT angiography (dCTA) score improves collateral assessment in acute ischemic stroke. This method, using CT perfusion source images, better predicts infarct size and progression than static CT angiography (sCTA).

Keywords:
CT perfusioncollateral circulationischemic stroke

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Area of Science:

  • Neuroradiology
  • Acute Ischemic Stroke Imaging
  • Cerebrovascular Disease

Background:

  • Static CT angiography (sCTA) may underestimate collateral flow in acute ischemic stroke.
  • Accurate collateral assessment is crucial for predicting stroke outcomes.

Purpose of the Study:

  • Develop and validate a direct, qualitative dynamic CT angiography (dCTA) collateral score.
  • Utilize CT perfusion (CTP) source images for a prognostic tool without post-processing software.

Main Methods:

  • Retrospective analysis of 112 anterior circulation ischemic stroke patients.
  • Comparison of a novel 4-point dCTA score with a 4-point sCTA score.
  • Linear regression to correlate scores with CTP-derived core/hypoperfusion volumes and infarct growth.

Main Results:

  • Dynamic CT angiography (dCTA) reclassified more patients to good collaterals than sCTA.
  • Both scores correlated with smaller core volumes, with dCTA showing superior model fit.
  • dCTA significantly modified the association between core volume and time since stroke onset.

Conclusions:

  • A dCTA score from CTP source images reliably predicts infarct size and progression.
  • dCTA offers a readily implementable tool for enhanced patient selection in acute stroke.
  • Dynamic assessment improves upon static methods for collateral evaluation.