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Publications

Journal Article Ahead of print

PubMed: 42274735 DOI: 10.1007/s00234-026-04047-z

Visual versus automated collateral scoring on CT angiography for predicting outcome after endovascular therapy for large-vessel occlusion stroke: a prospective multicentre study.

Neuroradiology

Authors: Jose Pablo Martinez-Gonzalez, Marina Guasch-Jimenez, Jorge Hernandez-Garcia, Joan Marti Fabregas, Joaquin Ortega-Quintanilla, Francisco Moniche, Isabel Fernández-Pérez, Elena De Celis-Ruiz, Marimar Freijo, Juan F Arenillas, Santiago Trillo-Senin, Jordi Branera, Lavinia Dinia, Josep Munuera, Jorge Villalba, Esther Granell, Ruben Guerrero, Andrea Lozano, Mario Tecame, Sara Castells, Anna Ramos-Pachón, Lluis Prats, Natalia Perez-De la Ossa, Garbiñe Ezcurra-Díaz, Alvaro Lambea-Gil, Joan Miquel Fernández-Vidal, Alejandro Martínez-Domeño, Ana Aguilera-Simón, Pol Camps-Renom

Affiliations

  • Advanced Medical Imaging, Artificial Intelligence and Imaging-Guided Therapy, Institut de Recerca Sant Pau (IR SANTPAU), Barcelona, Spain.
  • Diagnostic Imaging Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
  • Department of Neurology, Stroke Unit, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau, Barcelona, Spain.
  • Advanced Medical Imaging, Artificial Intelligence and Imaging-Guided Therapy, Institut de Recerca Sant Pau (IR SANTPAU), Barcelona, Spain.
  • Diagnostic Imaging Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
  • Department of Neurology, Stroke Unit, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau, Barcelona, Spain.
  • Interventional Neuroradiology Unit, Son Espases University Hospital, Palma de Mallorca, Spain.
  • Department of Neurology, Stroke Unit, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.
  • Hospital del Mar, Barcelona, Spain.
  • Department of Neurology and stroke center, La Paz University Hospital, Universidad Autónoma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain.
  • Stroke Unit, Cruces University Hospital, Biobizkaia Health Research Institute, Barakaldo, Spain.
  • Department of Medicine, University of Valladolid, Valladolid, Spain.
  • Department of Neurology, Hospital La Princesa, Madrid, Spain.
  • Corporació Sanitària Parc Taulí, Barcelona, Spain.
  • Department of Neurology, Stroke Unit, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau, Barcelona, Spain.

Abstract

PURPOSE

Collateral circulation (CC) is a key determinant of tissue viability and clinical outcome in large-vessel occlusion (LVO) stroke. Whether automated collateral scoring on single-phase CT angiography (sCTA) provides prognostic information comparable to traditional visual assessment remains uncertain. This study aimed to compare the predictive performance of visual versus automated collateral evaluation for functional outcome after endovascular therapy (EVT).

METHODS

We conducted a prospective multicentre cohort study including consecutive patients with anterior circulation LVO treated with EVT between 2020 and 2022. Collateral status on baseline sCTA was graded visually (Tan and ASITN/SIR scores) and automatically using Brainomix ® software. The primary endpoint was favourable 90-day outcome (modified Rankin Scale [mRS] 0-2). Multivariable logistic regression and ROC analyses compared the discriminative performance of visual and automated collateral assessments.

RESULTS

A total of 332 patients (mean age 72.6 ± 12.7 years; 48.5% female) were analysed. Good collateral status was independently associated with favourable outcome for both visual (Tan aOR 2.41, 95% CI 1.09-5.30; p = 0.029) and automated (aOR 2.45, 95% CI 1.11-5.24; p = 0.027) methods. Predictive performance was nearly identical (0.865 for visual and 0.867 for automated assessment; p = 0.777). Good collaterals were also associated with lower mortality and lower risk of symptomatic intracerebral haemorrhage.

CONCLUSION

Automated collateral scoring on baseline sCTA achieves equivalent predictive performance to expert visual assessment for functional outcome after EVT. Their added consistency and reproducibility support the integration of automated methods to standardise collateral evaluation across centres, particularly where immediate expert neuroradiological assessment is not available.

MeSH

Stroke, Angiography, Radiography, Therapeutics, Computed Tomography Angiography