No consensus on best CTA grading for leptomeningeal collaterals in stroke

A review of leptomeningeal collateral grading systems on single-phase CTA finds no consensus on which best captures anatomy, with high variability in reliability and feasibility; automated scoring may improve objectivity.

• Digital subtraction angiography (DSA) remains the gold standard for anatomic and functional collateral assessment, but is invasive.
• Single-phase CTA is the most widely used acute stroke imaging modality for collateral scoring.
• Automated, reproducible collateral scoring could provide more objective ratings but has not yet entered clinical routine.

Automated summary

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