More than 90% of the time I reach for a regular spider, with first choice a burnt orange body, followed by black, dark olive and yellow). Backup patterns include fall caddis, BWOS or other fall mays. I fish mainly larger flies (6s and 4s) reserving the smaller sizes for targeting pressured fish.
At least on the north Puget Sound streams that I fish I find the fish often hold close to wood and the closer I present my flies to that wood or under the over-hanging limb the more fish I catch. That means the effective presentation is putting our flies in jeopardy to snagging on the wood. For this reason, I like the simpler patterns (less tying time).
I don't find that cutthroat are usually short strikers but can be very quick in rejection our flies. To best deal with those quick rejections a strip set is your friend.
Curt