Objective The rate of progression of the ischemic lesion is variable in patients with stroke. We tested the hypothesis that the tissue saving effect of mechanical thrombectomy (MT) is greater in fast progressors.
Methods A single-center cohort of consecutive patients (n=242) with occlusions of the terminal internal carotid or M1 segment of the middle cerebral artery treated with MT (n=195) or best medical treatment (n=47), known time from onset, and full imaging (baseline CT perfusion and follow-up MRI) available was studied. The estimated infarct progression rate (eIPR) was calculated at baseline and patients were categorized as fast/slow progressors according to the median eIPR of 4.8 mL/hour. The primary outcome measure was the interaction between eIPR category and MT on infarct growth. The secondary outcomes assessed the effect of MT on final infarct volume and functional status in relation to the eIPR category. The safety outcomes were mortality and symptomatic intracranial hemorrhage.
Results The eIPR category had a modifying effect (Pi=0.017) of MT on infarct growth that was significantly reduced with MT only in fast progressors (median (IQR) 3.8 mL (−11–55) vs 41 mL (11–107) with medical treatment; p=0.009, adjusted p=0.045). There was also a significant interaction on final infarct volume (Pi=0.005), with a greater reduction after MT in fast progressors. The functional status improved with MT both in fast and slow progressors, with no significant modifying effect of eIPR category (Pi=0.201). There were also no significant interactions on safety outcomes.
Conclusion MT in stroke patients with large vessel occlusion limits infarct growth more significantly in fast progressors.
- CT perfusion
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ARJ and XU contributed equally.
Contributors AR and CL made substantial contributions to the conception and design of the study; collected and analyzed clinical data; acquired, processed and analyzed radiological data; and drafted the manuscript for intellectual concept. CM made substantial contributions to the collection and analysis of clinical data. SR, LL, SA, VO, and RT made a substantial contribution to the collection and analysis of clinical data. JB and JM made substantial contributions to the acquisition, processing, and analysis of radiological data. AC and XU made substantial contributions to the conception and design of the study; collected and analyzed clinical data; drafted the manuscript for intellectual content and revised the draft critically.
Competing interests None declared.
Ethics approval The local Ethics Committee at the Hospital Clinic approved the study (reg. code HCB/2018/0680).
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Not required.