Comparison of CTA and DSA collateral scores in predicting clinical outcome in anterior circulation stroke patients receiving endovascular treatment: A retrospective observational study.

In our study, we performed both computed tomographic angiography (CTA) and digital substraction angiography (DSA) collateral artery flow scoring in anterior system acute stroke patients who underwent mechanical thrombectomy (MT) within the first 16 hours. The study aimed to evaluate the consistency of both scoring methods and their relationship with the 90-day clinical outcomes of the patients. From January to December 2022, the files of patients with middle cerebral artery occlusion who underwent MT and were followed up at a stroke center were retrospectively reviewed. Demographic data, laboratory parameters, Alberta stroke program early computed tomography score, National Institutes of Health Stroke Scale score, grade of recanalization, symptomatic intracranial hemorrhage (European Cooperative Acute Stroke Study III criteria), and 90-day modified Rankin Scale values were recorded. Modified Rankin Scale ≤ 2 was considered a good clinical outcome. CTA and DSA images were independently evaluated by 2 experienced neurologists. The TAN score was used for CTA collateral scoring, while the ASITN score was used for DSA collateral scoring. Fleiss Kappa coefficient was used to assess inter-rater agreement and Spearman rho coefficient was used for correlation between the scores. At 90 days, 62 patients (70%) achieved good clinical outcome. Mean CTA and DSA collateral scores were significantly higher in patients with good outcome (P < .001 for both). Inter-rater agreement was substantial (CTA: κ = 0.65 [0.518-0.775], AC1 = 0.68 [0.556-0.796]; DSA: κ = 0.59 [0.456-0.713], AC1 = 0.61 [0.489-0.732]). In multivariate analysis, DSA collateral score was independently associated with good outcome (adjusted odd ratio [aOR]: 0.01; 95% CI: 0.00-0.46; P = .02), along with admission National Institutes of Health Stroke Scale score (aOR: 5.33; 95% CI: 1.57-18.07; P = .01), and admission Alberta stroke program early computed tomography score (aOR: 0.09; 95% CI: 0.01-0.68; P = .02). In patients undergoing MT, CTA and DSA collateral score ratings are predictive of clinical outcomes at 90-day and are strongly correlated with each other.