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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

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Characteristics and Outcomes of Fast Progressors Receiving Endovascular Treatment for Acute Large Vessel Occlusion: A

Mingming Zha1, Shuaiyu Chen2, Jinhua Wang1

  • 1Department of Neurology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

Cerebrovascular Diseases (Basel, Switzerland)
|June 29, 2025
PubMed

Insights

Fast progressors in acute large vessel occlusion strokes show higher severity, worse collaterals, and cardioembolic causes. These patients face worse outcomes after endovascular treatment (EVT), highlighting the need to consider infarction growth rate (IGR) in stroke management.

Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Stroke Medicine

Background:

  • Acute large vessel occlusion (LVO) stroke patients are categorized by infarction growth rate (IGR) into fast and slow progressors before endovascular treatment (EVT).
  • Characteristics of fast progressors and the adverse effects of rapid infarction growth remain incompletely understood.

Purpose of the Study:

  • To comprehensively review and characterize fast progressors in acute LVO stroke.
  • To investigate the clinical outcomes associated with rapid infarction growth rate before EVT.

Main Methods:

  • Systematic literature search of studies comparing fast and slow progressors before EVT, published up to March 24, 2025.
  • Meta-analysis of baseline characteristics and clinical outcomes from 8 pooled studies involving 2,718 patients.
  • Calculation of weighted odds ratios (OR) and mean differences (MD) with confidence intervals (CIs).

Main Results:

  • Fast progressors exhibited higher NIH Stroke Scale scores, increased rates of intravenous thrombolysis, more internal carotid artery occlusions, and poorer collateral status.
  • Cardioembolism was a prevalent etiology in fast progressors.
  • Fast IGR was linked to lower successful reperfusion rates, reduced good functional outcomes (mRS 0-2), and higher rates of symptomatic intracranial hemorrhage and 90-day mRS scores.

Conclusions:

  • Key features of fast progressors include stroke severity, proximal occlusion, poor collaterals, and cardioembolic etiology.
  • Fast progressors face significantly increased risks of adverse outcomes following EVT.
  • Incorporating IGR assessment into clinical practice and research is crucial for optimizing stroke management.
Abstract

Keywords:
EeperfusionEndovascular treatmentInfarction growth ratePrognosisStroke

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