Mangiafico et al reported a simple scale for reported collateral circulation following an acute ischemic stroke involving the anterior circulation. The status of the collateral circulation impacts the patient's outcome. The authors are from Careggi University Hospital in Florence, Italy.

Patient selection: acute ischemic stroke of the anterior circulation


Test: angiographic assessment of leptomeningeal collaterals in antero-posterior projection


CCS Grade

Retrograde Filling of Cortical ACA-MCA Territories




in the territory of the ACA


visualization of collaterals until the suprainsular segment of the MCA


visualization of collaterals until the insular segment of the MCA


visualization of collaterals until the alar segment of the MCA


complete filling of contralateral hemisphere through the ACoA


ACA = anterior cerebral artery

MCA = middle cerebral artery

ACoA = anterior communicating artery


A favorable outcome (modified Rankin scale 0 to 2 at 3 months) is associated with CCS grades 2 to 5.

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