Prognostic Predictive Value of Infarct Growth Rate in Acute Cerebral Infarction with Large Vessel Occlusion

This study evaluates the use of infarct growth rate (IGR) from computed tomography perfusion (CTP) imaging to predict poor prognosis in acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT).

We analyzed data from a prospective clinical database of patients admitted with anterior circulation large-vessel occlusive stroke from January 2022 to December 2024. IGR was defined as the ischemic core volume on CTP imaging divided by the time from stroke onset to imaging. Outcomes were assessed at 90 days using the modified Rankin scale (mRS). Multivariate logistic regression and restricted cubic spline analyses were employed to assess the independent and combined effects of IGR and NIHSS score on the clinical prognosis of AIS patients after thrombectomy. Receiver operating characteristic curve analysis was further utilized to evaluate the predictive performance of these associations.

A total of 232 patients satisfied the inclusion criteria. Among them, 83 patients (35.8% of the study cohort) exhibited a poor prognosis. After adjustment for potential confounders, an increased IGR was independently associated with a higher risk of poor prognosis (adjusted odds ratio: 1.17; 95% CI: 1.10-1.24; p < 0.001), a relationship which was further characterized as nonlinear (p for nonlinearity < 0.0001). The AUC for the combination of NIHSS score and IGR was 0.90 (95% CI: 0.86-0.94).

An elevated IGR was identified as an independent predictor of poor prognosis in patients with AIS who underwent EVT.