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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Early Infarct Growth Rate Correlation With Endovascular Thrombectomy Clinical Outcomes: Analysis From the SELECT

Amrou Sarraj¹, Ameer E Hassan², James Grotta¹

¹Department of Neurology (A.S., J.G., D.P., F.S., H.K.), The University of Texas at Houston.

|December 7, 2020

Summary

Early infarct growth rate (EIGR) predicts endovascular thrombectomy (EVT) outcomes. Slow infarct progression is linked to better functional independence after EVT, especially in later time windows.

Keywords:

brain infarction neuroimaging perfusion stroke, acute thrombectomy

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Area of Science:

Neurology
Radiology
Interventional Cardiology

Background:

Time from last-known well (LKW) and baseline imaging influence endovascular thrombectomy (EVT) outcomes.
Early infarct growth rate (EIGR) is a key metric for assessing infarct progression.

Purpose of the Study:

To define and validate the optimal EIGR cutoff for stratifying patients undergoing EVT.
To assess the correlation between EIGR, collateral status, and 90-day functional independence after EVT.

Main Methods:

Prospective multicenter cohort study (SELECT trial) involving 361 acute ischemic stroke patients.
EIGR calculated as ischemic core volume divided by time from LKW to imaging.
Patients stratified into slow (

Main Results:

Optimal EIGR cutoff identified as <10 mL/h; 200 EVT patients were slow and 85 fast progressors.
Slow progressors demonstrated significantly better collateral status and higher rates of functional independence (61% vs 35%).
EIGR independently correlated with functional independence; each 5 mL/h increase in EIGR decreased good outcome odds by 14%.

Conclusions:

EIGR is a strong predictor of collateral status and clinical outcomes following EVT.
Fast progressors experience worse outcomes with EVT, particularly beyond 6 hours from stroke onset.
EIGR aids in patient selection for EVT, optimizing treatment decisions and improving outcomes.