Usefulness of Computed Tomographic Perfusion Imaging for Appropriate Diagnosis of Acute Cerebral Vessel Occlusion in Case of Anatomic Variations of the Circle of Willis

Mechanical thrombectomy (MT) is an effective treatment in patients with acute ischemic stroke (AIS) due to emergent large-vessel occlusion in the anterior circulation. Occlusion of the anterior cerebral artery (ACA) affects up to 15% of these patients. Here we report a case of an old-aged patient with an successful MT of an embolic A2-segment occlussion with the anatomic variation of a triplication. Triplication of ACA is a rare anatomical variation, and the occlusion could have been easily overlooked in case of not performing the CT-perfusion (CTP) sequences. As anatomical variations of the circle of Willis are present in most subjects, CTA alone might be limited in the acute setting, particularly for young residents performing the first view on call. This case highlights the importance of including CTP in the initial CT-diagnostic algorithm in AIS patients who are basically eligible for recanalization therapies, irrespective of inconspicuous initial findings in CTA.

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Carotid endarterectomy in patients with foetal-type posterior circle of Willis: Is there an indication for local anaesthesia?

VASA ◽

10.1024/0301-1526/a000138 ◽

2011 ◽

Vol 40 (5) ◽

pp. 404-407

Author(s):

Maras ◽

Tzormpatzoglou ◽

Papas ◽

Papanas ◽

Kotsikoris ◽

...

Keyword(s):

Carotid Endarterectomy ◽

Local Anaesthesia ◽

Anatomical Variation ◽

Anatomical Variations ◽

Circle Of Willis ◽

Variable Degree ◽

Operative Complications ◽

The Right ◽

Ica Stenosis ◽

Symptomatic Stenosis

Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.

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Normative distribution of posterior circulation tissue time-to-maximum: Effects of anatomic variation, tracer kinetics, and implications for patient selection in posterior circulation ischemic stroke

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x20982395 ◽

2021 ◽

pp. 0271678X2098239

Author(s):

Adam E Goldman-Yassen ◽

Matus Straka ◽

Michael Uhouse ◽

Seena Dehkharghani

Keyword(s):

Ischemic Stroke ◽

Selection Criteria ◽

Arterial Input Function ◽

Anatomic Variation ◽

Input Function ◽

Posterior Circulation ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Perfusion Time

The generalization of perfusion-based, anterior circulation large vessel occlusion selection criteria to posterior circulation stroke is not straightforward due to physiologic delay, which we posit produces physiologic prolongation of the posterior circulation perfusion time-to-maximum (Tmax). To assess normative Tmax distributions, patients undergoing CTA/CTP for suspected ischemic stroke between 1/2018-3/2019 were retrospectively identified. Subjects with any cerebrovascular stenoses, or with follow-up MRI or final clinical diagnosis of stroke were excluded. Posterior circulation anatomic variations were identified. CTP were processed in RAPID and segmented in a custom pipeline permitting manually-enforced arterial input function (AIF) and perfusion estimations constrained to pre-specified vascular territories. Seventy-one subjects (mean 64 ± 19 years) met inclusion. Median Tmax was significantly greater in the cerebellar hemispheres (right: 3.0 s, left: 2.9 s) and PCA territories (right: 2.9 s; left: 3.3 s) than in the anterior circulation (right: 2.4 s; left: 2.3 s, p < 0.001). Fetal PCA disposition eliminated ipsilateral PCA Tmax delays (p = 0.012). Median territorial Tmax was significantly lower with basilar versus any anterior circulation AIF for all vascular territories (p < 0.001). Significant baseline delays in posterior circulation Tmax are observed even without steno-occlusive disease and vary with anatomic variation and AIF selection. The potential for overestimation of at-risk volumes in the posterior circulation merits caution in future trials.

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Prognostic importance of CT ASPECTS and CT perfusion measures of infarction in anterior emergent large vessel occlusions

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014461 ◽

2018 ◽

Vol 11 (7) ◽

pp. 670-674 ◽

Cited By ~ 3

Author(s):

Syed Ali Raza ◽

Clara M Barreira ◽

Gabriel M Rodrigues ◽

Michael R Frankel ◽

Diogo C Haussen ◽

...

Keyword(s):

Ct Perfusion ◽

Area Under The Curve ◽

Large Vessel ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Nihss Score ◽

Median Baseline ◽

Ct Head ◽

Prognostic Importance ◽

Contrast Ct

BackgroundAge, neurologic deficits, core volume (CV), and clinical core or radiographic mismatch are considered in selection for endovascular therapy (ET) in anterior circulation emergent large vessel occlusion (aELVO). Semiquantitative CV estimation by Alberta Stroke Programme Early CT Score (CT ASPECTS) and quantitative CV estimation by CT perfusion (CTP) are both used in selection paradigms.ObjectiveTo compare the prognostic value of CTP CV with CT ASPECTS in aELVO.MethodsPatients in an institutional endovascular registry who had aELVO, pre-ET National Institutes of Health Stroke Scale (NIHSS) score, non-contrast CT head and CTP imaging, and prospectively collected 3-month modified Rankin Scale (mRS) score were included. Age- and NIHSS-adjusted models, including either CT ASPECTS or CTP volumes (relative cerebral blood flow <30% of normal tissue, total hypoperfusion, and radiographic mismatch), were compared using receiver operator characteristic analyses.ResultsWe included 508 patients with aELVO (60.8% M1 middle cerebral artery, 34% internal carotid artery, mean age 64.1±15.3 years, median baseline NIHSS score 16 (12–20), median baseline CT ASPECTS 8 (7–9), mean CV 16.7±24.8 mL). Age, pre-ET NIHSS, CT ASPECTS, CV, hypoperfusion, and perfusion imaging mismatch volumes were predictors of good outcome (mRS score 0–2). There were no differences in prognostic accuracies between reference (age, baseline NIHSS, CT ASPECTS; area under the curve (AUC)=0.76) and additional models incorporating combinations of age, NIHSS, and CTP metrics including CV, total hypoperfusion or mismatch volume (AUCs 0.72–0.75). Predicted outcomes from CT ASPECTS or CTP CV-based models had excellent agreement (R2=0.84, p<0.001).ConclusionsIncorporating CTP measures of core or penumbral volume, instead of CT ASPECTS, did not improve prognostication of 3-month outcomes, suggesting prognostic equivalence of CT ASPECTS and CTP CV.

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Estudo da Variação Anatômica da Inserção do Proximal do Músculo Peitoral Menor / Study of the anatomical Variation of Proximal Insertion of Pectoralis Muscle

REVISTA CIÊNCIAS EM SAÚDE ◽

10.21876/rcsfmit.v1i1.20 ◽

1970 ◽

Vol 1 (1) ◽

pp. 67-71 ◽

Cited By ~ 1

Author(s):

Bernardo Barcellos Terra ◽

Eduardo Antônio de Figueiredo ◽

Gustavo Cará Monteiro ◽

Alberto de Castro Pochini ◽

Carlos Vicente Andreoli ◽

...

Keyword(s):

Anatomic Variation ◽

Anatomical Variation ◽

Adhesive Capsulitis ◽

Anatomical Variations ◽

Coracoid Process ◽

Type I ◽

The Third ◽

Pectoralis Minor ◽

Bilateral Case ◽

Change Of Type

Introdução: O músculo peitoral menor é um músculo delgado, que se origina do terceiro, quarto e quinto arcos costais e se insere proximalmente na superficie supero-medial do processo coracóide. Sua variação anatômica pode estar correlacionada com diversas patologias do ombro e estar implicada até mesmo na falha dos tratamentos de capsulite adesiva. Le Double em seu clássico trabalho descreveu três tipos de variações anatômicas e relatou uma incidência em torno de 15% desta variação. O objetivo deste trabalho foi analisar a inserção proximal do peitoral menor e relatar suas variações anatômicas. Métodos: Foram dissecados 12 cadáveres (24 ombros), onde foi realizada uma via deltopeitoral ampliada, isolada a inserção do tendão do peitoral menor e estudado sua inserção proximal. Foram excluídos os cadáveres com cicatrizes na região do ombro ou limitação importante do arco de movimento passivo. Resultados: Entre os 12 cadáveres dissecados, 8 eram homens e 4 mulheres, com idade média de 53,9 anos. Dos 24 ombros dissecados, 21 (87,5%) apresentaram a inserção do músculo totalmente na porção superior e medial do terço distal do processo coracóide. Em 3 ombros (12,5%), observou-se as variações anatômicas descritas por Le Double: um caso bilateral, com variação do tipo I e um caso unilateral direito, com variação do tipo II. Conclusão: Conhecer a anatomia do peitoral menor e suas possíveis variações anatômicas é importante para o manejo e entendimento das patologias do ombro.Introduction: The pectoralis minor is a thin muscle that originates from the third, fourth and fifth ribs and inserts proximally on the upper surface of the coracoid process and medial. Its action pull ventral and caudal the scapula, lowering his side angle in adduction of the arm. It also participates in the elevation of the third, fourth and fifth ribs during inspiration. His anatomical variation may be correlated with various pathologies of the shoulder and even be implicated in the failure of treatment of adhesive capsulitis. Le Double in his classic paper described three types of anatomical variations and reported an incidence of around 15% of this variation. Our goal was to analyze the proximal attachment of the pectoralis minor and report their anatomical variations. Methods: We dissected 12 cadavers (24 shoulders), 8 men and 4 women, mean age of 53.9 years. Was performed an extended deltopectoral approach, isolated insertion of the pectoralis minor tendon and studied the proximal attachment of the muscle. We excluded the bodies with scars on the shoulder or important limitation of passive range of motion. Results: Of the 24 shoulders dissected in 21 (87.5%) the insertion of the muscle occurred entirely in the upper medial and distal third of the coracoid process. In three shoulders (12.5%), we observed the anatomical variations described by Le Double. A bilateral case, with change of type I and one case with unilateral right variation of type II. Conclusion: Knowledge of the anatomy of the pectoralis minor and the possible anatomical variations is important for the understanding and management of pathologies of the shoulder, especially in techniques involving the coracoid process, or even the understanding of pathologies that can possibly have as the genesis of this anatomic variation of muscle.

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Digital Subtraction Angiographic Study of Circle of Willis in Indian Population in a Tertiary Super-Specialty Hospital

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v3i2.36774 ◽

2018 ◽

Vol 3 (2) ◽

pp. 99-105

Author(s):

Muhammad Abdul Momen Khan ◽

Shakir Husain ◽

Md Shohidul Islam ◽

Md Amir Hossain

Keyword(s):

Digital Subtraction Angiography ◽

Cerebrovascular Disorders ◽

Clinical Importance ◽

Uttar Pradesh ◽

Anatomical Variations ◽

Circle Of Willis ◽

Anterior Communicating Artery ◽

Digital Subtraction ◽

Anterior Circulation ◽

Cross Sectional

Background: Circle of Willis is an anastomotic polygon at the base of the brain which forms an important collateral network to maintain adequate cerebral perfusion. Changes in the normal morphology of the circle may causes the appearance and severity of symptoms of cerebrovascular disorders, such as aneurysms, infarctions and other vascular anomalies.Objectives: The aim of the present study was to analyses the anatomical variations of the circle of Willis by observing the variations in the cerebral arterial circle and was to clarify the clinical importance of these variations in certain forms of cerebrovascular diseases.Methodology: This cross-sectional study was conducted in the department of Neurointervention of Max Super-speciality Hospital, New Delhi, India and Neo multispeciality Hospital, Noida, Uttar Pradesh (UP), India during July 2016 to December 2016 for a period of six (6) months. Patients who were admitted in the Neurointervention department for digital subtraction angiography (DSA) were included in this study. The circle of Willis was then analyzed with the special reference to the complete or incomplete circle, any asymmetry in the configuration and variations in the size, and number of the component vessels, circle with multiple anomalies and absence, fenestration, duplication or triplication of any of the vessels.Results: Morphology and variations of the circle of Willis were studied in 74 patients undergone digital subtraction angiography (DSA). The normal pattern of circle of Willis was observed in 40(54.06%) cases and the remaining 34(45.94%) cases had one or more variations; however, 24(70.58%) cases had variations in the anterior circulation and 10(29.42%) cases had variations in the posterior circulation. 17(50%) cases had variations on the right side compared to 13(38.24%) variations on the left side. 4(11.76%) cases had variations in the anterior communicating artery. Incomplete circle of Willis were found 12(35.28%) cases. Multiple variations were observed in 11 cases (32.35%) in this study. In 4 cases anterior communicating artery aneurysms were observed.Conclusion: Variation of circle of Willis is common in this study of Indian population.Journal of National Institute of Neurosciences Bangladesh, 2017;3(2): 99-105

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Association between pre-treatment perfusion profile and cerebral edema after reperfusion therapies in ischemic stroke

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x211017696 ◽

2021 ◽

pp. 0271678X2110176

Author(s):

Felix C Ng ◽

Leonid Churilov ◽

Nawaf Yassi ◽

Timothy J Kleinig ◽

Vincent Thijs ◽

...

Keyword(s):

Ischemic Stroke ◽

Cerebral Edema ◽

Significant Interaction ◽

Ct Perfusion ◽

Physiological State ◽

Pooled Analysis ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Pre Treatment ◽

Core Volume

The relationship between reperfusion and edema is unclear, with experimental and clinical data yielding conflicting results. We investigated whether the extent of salvageable and irreversibly-injured tissue at baseline influenced the effect of therapeutic reperfusion on cerebral edema. In a pooled analysis of 415 patients with anterior circulation large vessel occlusion from the Tenecteplase-versus-Alteplase-before-Endovascular-Therapy-for-Ischemic-Stroke (EXTEND-IA TNK) part 1 and 2 trials, associations between core and mismatch volume on pre-treatment CT-Perfusion with cerebral edema at 24-hours, and their interactions with reperfusion were tested. Core volume was associated with increased edema (p < 0.001) with no significant interaction with reperfusion (p = 0.82). In comparison, a significant interaction between reperfusion and mismatch volume (p = 0.03) was observed: Mismatch volume was associated with increased edema in the absence of reperfusion (p = 0.009) but not with reperfusion (p = 0.27). When mismatch volume was dichotomized at the median (102 ml), reperfusion was associated with reduced edema in patients with large mismatch volume (p < 0.001) but not with smaller mismatch volume (p = 0.35). The effect of reperfusion on edema may be variable and dependent on the physiological state of the cerebral tissue. In patients with small to moderate ischemic core volume, the benefit of reperfusion in reducing edema is related to penumbral salvage.

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Imaging Challenges in the Diagnosis of Anatomical Variations of the Supra-Aortic Vessels: A Case Report and Review of Literature

Diagnostics ◽

10.3390/diagnostics12010169 ◽

2022 ◽

Vol 12 (1) ◽

pp. 169

Author(s):

Alexandra Dădârlat-Pop ◽

Adrian Molnar ◽

Alexandru Oprea ◽

Raluca Tomoaia ◽

Bianca Boros ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Anatomic Variation ◽

Anatomical Variations ◽

Left Vertebral Artery ◽

Left Internal Carotid Artery ◽

Computed Tomographic ◽

Cardiology Department ◽

History Of

A 73-year-old woman was referred to our Cardiology Department due to recurrent headaches and dizziness. She had a history of hypertension of 10 years. In the territorial hospital, left internal carotid artery significant stenosis was suspected. Neurological examination and laboratory tests were normal. A neck vascular ultrasound was performed, showing a low bifurcation of the left common carotid artery (CCA) and a hypoplastic left internal carotid artery (ICA) with a sinuous path at the cervical level. Therefore, a computed tomographic (CT) angiography examination of the head and neck vessels was performed. The images confirmed the presence of a hypoplastic left ICA, anatomic variation in the left CCA, and also showed that the left vertebral artery (VA) was stemming directly from the aortic arch, exhibiting a kinking trajectory.

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RNF213 p.R4810K (c.14429G > A) Variant Determines Anatomical Variations of the Circle of Willis in Cerebrovascular Disease

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.681743 ◽

2021 ◽

Vol 13 ◽

Author(s):

Futoshi Eto ◽

Takeshi Yoshimoto ◽

Shuhei Okazaki ◽

Kunihiro Nishimura ◽

Shiori Ogura ◽

...

Keyword(s):

Cerebrovascular Disease ◽

Multivariate Logistic Regression Analysis ◽

Ring Finger ◽

Anatomical Variations ◽

Cross Sectional Study ◽

Circle Of Willis ◽

Anterior Communicating Artery ◽

Anterior Circulation ◽

Cross Sectional ◽

Vascular Abnormalities

IntroductionDysregulation of the RING finger protein 213 (RNF213) gene impairs vascular formation in experimental animal models. In addition, vascular abnormalities in the circle of Willis are associated with cerebrovascular disease. Here, we evaluated the relationship between the East Asian founder variant RNF213 p.R4810K and consequent anatomical variations in the circle of Willis in cerebrovascular disease.Patients and MethodsThe present study is an observational cross-sectional study. It included patients with acute anterior circulation non-cardioembolic stroke admitted to our institution within 7 days of symptom onset or last-known-well from 2011 to 2019, and those who participated in the National Cerebral and Cardiovascular Center Biobank. We compared anatomical variations of the vessels constituting the circle of Willis between RNF213 p.R4810K (c.14429G > A) variant carriers and non-carriers using magnetic resonance angiography and assessed the association between the variants and the presence of the vessels constituting the circle of Willis. Patients with moyamoya disease were excluded.ResultsFour hundred eighty-one patients [146 women (30%); median age 70 years; median baseline National Institutes of Health Stroke Scale score 5] were analyzed. The RNF213 p.R4810K variant carriers (n = 25) were more likely to have both posterior communicating arteries (PComAs) than the variant non-carriers (n = 456) (56% vs. 13%, P < 0.01). Furthermore, variant carriers were less likely to have an anterior communicating artery (AComA) than non-carriers (68% vs. 84%, P = 0.04). In a multivariate logistic regression analysis, the association of RNF213 p.R4810K variant carriers with the presence of both PComAs and the absence of AComA remained significant.ConclusionOur findings suggest that the RNF213 p.R4810K variant is an important factor in determining anatomical variations in the circle of Willis.

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Abstract WP19: Reliability of CT Perfusion in the Posterior Circulation in Comparison to the Anterior Circulation

Stroke ◽

10.1161/str.51.suppl_1.wp19 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Srijan Adhikari ◽

Justin Moore ◽

Abid Y Qureshi

Keyword(s):

Ct Perfusion ◽

Infarct Volume ◽

Posterior Circulation ◽

Large Vessel ◽

Anterior Circulation ◽

Kendall’S Tau ◽

Mean Velocity ◽

Vessel Occlusion ◽

Kendall's Tau ◽

Nonparametric Correlation

Background: DAWN and DEFUSE-3 excluded posterior-circulation cases, but in practice endovascular therapy (EVT) is common due to life-threatening large-vessel occlusions. Often CT perfusion (CTP) is acquired to aid in the decision-making of these cases, but the reliability of using CT perfusion in the posterior-circulation is unknown Hypothesis: Given the differences in hemodynamics (~20% of total CBF to the basilar, reduced mean velocity, and differences in collateral supply) penumbra estimates using RAPID software will be less accurate in predicting the final infarct volume on DWI. Methods: In patients who did not receive any treatment (tPA or EVT), the Tmax >6s, as operationally defined as penumbra, should approximate the infarct on DWI. As such, only posterior circulation patients without EVT or tPA were included. Anterior circulation patients were matched on demographics, medical history, outcomes. A ratio of Tmax/DWI was calculated to assess how closely perfusion approximated final infarct folume. Nonparametric correlation with Kendall’s tau-b was also performed. Results: Eleven patients with a posterior circulation large-vessel occlusion (pc-LVO) were compared to 30-matched patients with anterior circulation (ac-LVO). Age was 62.4±16 for ac-LVO vs. 64.5±13 for pc-LVO. Significant differences were seen in sex with ac-LVO 82% male, and pc-LVO 46% male (t=-2.06 p=0.046). Pc-LVO also had more subjects with an unknown last known well. Mean admission NIHSS was 15.6±8 ac-LVO, and 16.4±10 in pc-LVO group was similar. Mean discharge NIHSS was 12.6±9 ac-LVO vs 12.4±10 pc-LVO. NO signficicant difference in 30d mRS, 24h NIHSS, or mortality within 90d. As excpected in the anterior circulation cases final infarct volume correlated with Tmax>6s Kendall’s tau-b=0.57 (p=0.000013), and Tmax>8s (tau-b=0.55), Tmax>10s (tau-b=0.55. Whereas, In the posterior circulation Tmax>6s (tau-b=0.41, N.S.), but Tmax>8s (tau-b=0.64, p=0.007) and Tmax>10(tau-b=0.69, p=0.005). Seen another way the ratio of Tmax>6s:DWI = 2.47 (ac-LVO) vs 5.84 (pc-LVO) (t=-1.22, p=0.004, but Tmax>8s 1.57 vs 1.50 (t=0.11, p=9.12). Conclusion: Final infarct volume was not significantly associated with Tmax>6s in posterior circulation cases. Instead Tmax>8s is more reliable.

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Abstract WP68: CT Perfusion Collateral Index in Assessment of Collaterals in Patients With Acute Ischemic Stroke: A New Imaging Biomarker

Stroke ◽

10.1161/str.51.suppl_1.wp68 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Kambiz Nael ◽

Jonathan Larson ◽

Yu Sakai ◽

Jared Goldstein ◽

Jacob Deutsch ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Ct Perfusion ◽

Imaging Biomarker ◽

Collateral Flow ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Good Functional Outcome ◽

Infarction Volume

Purpose: Perfusion collateral index (PCI) has been recently defined as a promising measure of collateral flow. We aim to evaluate the collateral status via CT-based PCI in association with outcome measures such as final infraction volume, recanalization status and functional outcome in patients presenting with acute ischemic stroke (AIS) and in a comparative analysis against CTA and DSA collateral scores. Methods: AIS patients with anterior circulation large vessel occlusion who had baseline CTA and CT perfusion and underwent endovascular treatment were included. CTA collateral scores were calculated using modified Tan score and DSA collateral scores were evaluated by ASITN grading. In addition, previously described PCI defined as the volume of moderately hypoperfused tissue (ATD 2-6sec ) multiplied by its corresponding rCBV was calculated in each patient. The association of CTA and DSA collateral scores and PCI were assessed against 3 measured outcomes: 1) Final infarction volume obtained from follow up MRI; 2) Final recanalization status defined by TICI scores; 3) Functional outcome measured by 90-day mRS. Results: A total of 53 patients met inclusion criteria (27F; mean/SD age: 70.1 ± 13 years; median NIHSS: 14). Final infarction volume (mean/SD: 30/40 mL), excellent recanalization defined by TICI >2C was achieved in 36 (68%) patients, and 23 patients (43%) had good functional outcome (mRS <2). Having good collaterals on all 3 modalities (CTA, DSA, CTP-PCI) were associated with significantly (p<0.05) smaller infarction volume. However only good collaterals determined by CTP-PCI was predictive of achieving excellent recanalization (p=0.001) or good functional outcome (p=0.01) ( Figure 1 ). Conclusion: Collateral status assessed via CT-PCI outperforms CTA and DSA collateral scores in prediction of excellent recanalization and good functional outcome and may be a promising imaging biomarker of collateral status in patients with AIS.

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