Prevalence and Temporal Distribution of Fast and Slow Progressors of Infarct Growth in Large Vessel Occlusion Stroke

Abstract

Background and Purpose— Fast and slow progressors of infarct growth due to anterior circulation large vessel occlusion are commonly observed in clinical practice. We aimed to estimate the prevalence and temporal distribution of fast and slow progressors among anterior circulation large vessel occlusion patients diagnosed within 24 hours of stroke onset. Methods— Single-center retrospective study of all patients with anterior circulation large vessel occlusion who underwent baseline computed tomographic perfusion or magnetic resonance imaging within 24 hours of stroke onset. Prevalence was determined for fast progressors (ischemic core >70 mL, <6 hours of stroke onset) and slow progressors (ischemic core ≤30 mL, >6–24 hours of stroke onset). Results— One hundred eighty-five patients were included. The median time interval from stroke onset to baseline core imaging was 7.6 hours (interquartile range, 3.9–13.2), and median core volume was 17 mL (range, 0–405). Patients had core volume ≤70 mL in 72% of cases in the overall cohort. The prevalence of fast progressors was 25% (95% CI, 17%–37%) and reached 40% (95% CI, 24%–59%) between 3 and 4.5 hours after stroke onset. The prevalence of slow progressors was 55% (95% CI, 46%–64%) and was similar across time intervals beyond 6 hours after stroke onset. Conclusions— Most anterior circulation large vessel occlusion patients had small-to-moderate ischemic core volume, irrespective of early or delayed presentation within 24 hours of stroke onset. Fast progressors were highly prevalent between 3 and 4.5 hours after stroke onset.

Stroke Treatment Delay Limits Outcome After Mechanical Thrombectomy: Stratification by Arrival Time and ASPECTS

“…For instance, patients with high ASPECTS (vs. intermediate or low) have a smaller core 11 and thus are at the highest risk for infarct growth when compared to those with a completed or near completed infarct. Moreover, past studies have shown that the rate of infarct growth is the highest in patients presenting early on from symptoms 12 and slowest in patients presenting in the extended time window 13 …”

Mechanical Thrombectomy for Acute Stroke: Early versus Late Time Window Outcomes

“…A significant number of patients presenting in the extended window do not have favorable imaging profile 35 . Moreover, those with favorable profile (slow progressors), become ineligible for treatment if not recanalized immediately after onset and develop extensive infarction leading to poor outcomes 36,37 . Patient presenting with favorable penumbral pattern on imaging should receive thrombectomy expeditiously with careful monitoring of imaging‐to‐skin puncture and imaging‐to‐recanalization time metrics.…”

Predictive factors of functional independence after optimal reperfusion in anterior circulation ischaemic stroke with indication for intravenous thrombolysis plus mechanical thrombectomy

“…It therefore seems important to demonstrate for this specific population that age and ischaemic core are such powerful prognostic factors that the treatment effect of bridging revascularization therapy does not affect their direction and only slightly diminishes their impact. This can partly be explained by the higher rate of fast progressors in the first 6 h of symptom onset; it is an argument for optimizing the stroke network by accelerating access to MT for patients with proximal intracranial arterial occlusion [25]. The baseline NIHSS score, in addition to the ASPECTS, could help to identify these rapid progressors who, at the time of admission imaging, still have a reduced ischaemic core with a large hypoperfused area (due to the involvement of arterial leptomeningeal collaterality) but who will probably constitute an area of extensive ischaemia between the MRI and the angiographic reperfusion.…”