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Case series
Fast and slow progressors of infarct growth in basilar artery occlusion strokes
  1. Shashvat M Desai1,2,
  2. Daniel A Tonetti3,
  3. Tudor G Jovin4,
  4. Ashutosh P Jadhav2
  1. 1Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
  3. 3Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  4. 4Neurology, Cooper University Hospital, Camden, New Jersey, USA
  1. Correspondence to Dr Ashutosh P Jadhav, Neurology, Barrow Neurological Institute, Phoenix, AZ 85013, USA; jadhav.library{at}


Background Heterogeneity in the infarct growth rate among anterior circulation large vessel occlusion (LVO) strokes has triage and treatment implications. Such data are lacking for basilar artery occlusion (BAO) strokes. We aim to describe the variability in brainstem infarct volume at presentation and compute the distribution of the infarct growth rate (IGR) and rate of loss of neurons during BAO strokes.

Methods A retrospective review of consecutive patients with BAO stroke with pretreatment MRI was performed. Ischemic core volume was manually calculated (product of slice thickness and sum of area of region of interests) for the brainstem lesion. The distribution of various brainstem infarct volume groups was analyzed and the IGR (including rate of loss of neurons) was computed.

Results Fifty-nine patients were included. Mean age was 64±13 and 34% were men. Mean National Institutes of Health Stroke Scale score was 20±11 and time to MRI was 9±5 hours. Mean brainstem ischemic core volume was 4.5±4.6 mL. According to predefined thresholds, 13% and 6% of patients with BAO stroke in the 0–6 hour time window were fast (5–10 mL) and ultra-fast progressors (>10 mL), respectively, and 14% of patients in the 6–24 hour time window were slow progressors (<1 mL). Median and mean rate of loss of neurons was 146 300 neurons/min and 261 300 (±400 000) neurons/min, respectively, and ranged from <19 400 to >2.12 million.

Conclusion Approximately 14% of BAO strokes are slow progressors and 19% are fast/ultra-fast progressors, with the rate of loss of neurons ranging from <19 000 to >2.1 million/min. Large heterogeneity exists in brainstem infarct volume at presentation and IGR among patients with BAO stroke.

  • stroke
  • thrombectomy

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  • Contributors Conception and design: SMD, APJ. Acquisition of data: SMD. Analysis and interpretation of data: All. Drafting the article: SMD, DAT. Critically revising the article: All. Administrative/technical/material support: All. Study supervision: APJ.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests TGJ: Consultant: Stryker Neurovascular (PI DAWN unpaid), Biogen (modest); Ownership interest: Anaconda (modest); Advisory Board/Investor: FreeOx Biotech (modest); Advisory Board/Investor: Route92 (modest); Advisory Board/Investor: Blockade Medical (modest), Silk Road (modest), Consultant; Honoraria: Cerenovus (modest), DSMB.

  • Patient consent for publication Not required.

  • Ethics approval STUDY20010015.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data used to prepare this manuscript may be made available on reasonable request to the corresponding author.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.