Early Infarct Growth Rate Correlation With Endovascular Thrombectomy Clinical Outcomes

Background and Purpose: Time elapsed from last-known well (LKW) baseline imaging results are influential on endovascular thrombectomy (EVT) outcomes. Methods: In a prospective multicenter cohort study of selection for (SELECT [Optimizing Patient’s Selection Endovascular Treatment in Acute Ischemic Stroke], the early infarct growth rate (EIGR) was defined as ischemic core volume perfusion (relative cerebral blood flow<30%) divided by time LKW to imaging. The optimal EIGR cutoff identified maximizing sum sensitivity specificity correlate best with favorable outcome improve its predictability. Patients were stratified into slow progressors if EIGR<cutoff fast EIGR?the cutoff. Good collaterals computed tomography hypoperfusion intensity ratio <0.4 angiography collateral score >2. primary 90-day functional independence (modified Rankin Scale =0–2). Results: Of 445 consented, 361 (285 EVT, 76 medical management only) patients met inclusion criteria. <10 mL/h; 200 EVT 85 progressors. Fast had higher median National Institutes Health Stroke (19 versus 15, P <0.001), shorter groin puncture (180 266 minutes, <0.001). Slow better perfusion: (adjusted odds [aOR]: 5.11 [2.43–10.76], <0.001) angiography: collaterals-score (aOR: 4.43 [1.83–10.73], =0.001). independently correlated after adjusting age, Scale, puncture, reperfusion Thrombolysis Cerebral Infarction ?2b), IV-tPA (intravenous tissue-type plasminogen activator), transfer status 0.78 [0.65–0.94], =0.01). rates (121 [61%] 30 [35%], 3.5 times likelihood achieving modified =0–2 (aOR=2.94 [95% CI, 1.53–5.61], =0.001) compared progressors, who substantially worse clinical outcomes both late window. good decreased 14% each 5 mL/h increase (aOR, 0.87 [0.80–0.94], declined more rapidly Conclusions: strongly correlates EVT. demonstrated when receiving beyond 6 hours stroke onset those received within hours. Registration: URL: https://clinicaltrials.gov . Unique identifier: NCT02446587.