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Published on: September 25, 2019
Factors Associated With Fast Early Infarct Growth in Patients With Acute Ischemic Stroke With a Large Vessel
Pierre Seners1, Nicole Yuen2, Jean-Marc Olivot2
1From the Stanford Stroke Center (P.S., N.Y., M.M., S.C., G.W.A.), Palo Alto, CA; Neurology Department (P.S., M.O.), Hôpital Fondation A. de Rothschild; Institut de Psychiatrie et Neurosciences de Paris (IPNP) (P.S.), U1266, INSERM, Paris; Acute Stroke Unit (J.M.O., J.-F.A.), Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, INSERM, UPS, France; Radiology Department (J.J.H.), Stanford University, Palo Alto, CA; Neurology Department (J.B.E.P., E.C.), Geneva University Hospital, Switzerland; Stroke Center (D.S., P.M., A.S.), Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland; Neuroradiology Department (M.W., H.C.), MD Anderson Cancer Center, University of Texas, Houston; Neuroradiology Department (C.C.), Toulouse University Hospital; Stroke Unit (I.S., J.S.), Bordeaux University Hospital; and Radiology Department (M.G.L.), Hôpital Fondation A. de Rothschild, Paris, France. pierre.seners@gmail.com.
The hypoperfusion intensity ratio (HIR) is the key predictor of early infarct growth rate in acute ischemic stroke with large vessel occlusion. This finding holds true across CT and MRI imaging, aiding in treatment decisions.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Predicting early infarct growth rate (EIGR) in acute ischemic stroke with large vessel occlusion (LVO) is crucial but lacks established optimal methods.
- Collateral circulation assessment is vital, with the hypoperfusion intensity ratio (HIR) emerging as a key metric.
Purpose of the Study:
- To investigate factors associated with EIGR in LVO stroke.
- To focus on the role of collateral status, specifically HIR, in predicting infarct progression.
- To determine the consistency of these associations across different imaging modalities (CT and MRI).
Main Methods:
- Retrospective multicenter study of 1,127 patients with anterior circulation LVO stroke and baseline perfusion imaging (CT or MRI) within 24 hours.
- EIGR calculated as infarct volume/onset-to-imaging time; fast progressors defined as EIGR ≥10 mL/h.
- HIR measured using RAPID software; multivariable logistic regression analyzed factors associated with fast progression, with separate analyses for CT and MRI.
Main Results:
- The HIR was the primary factor associated with fast infarct progression, with significant differences across HIR quartiles (p < 0.001).
- Approximately 37% of patients were classified as fast progressors.
- Associations between HIR and fast progression were consistent across both CT and MRI modalities.
- Fast progression was independently linked to poor 3-month functional outcomes in both CT and MRI cohorts.
Conclusions:
- The hypoperfusion intensity ratio (HIR) is a robust predictor of fast infarct progression in LVO stroke, irrespective of imaging modality.
- These findings have significant implications for designing neuroprotection trials and guiding triage decisions at stroke centers.
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