Ravinder-Jeet Singh, MBBS, DM
Puhr-Westerheide D, Tiedt S, Rotkopf LT, Herzberg M, Reidler P, Fabritius MP, et al. Clinical and Imaging Parameters Associated With Hyperacute Infarction Growth in Large Vessel Occlusion Stroke. Stroke. 2019;50:2799–2804.
Infarct growth among patients with large vessel occlusion (LVO) is highly variable. In some patients, infarct progresses very quickly (rapid progressor) and they have no or small penumbra even during early hours after their stroke onset, while others progress more slowly (slow progressor) and have large penumbral tissue at later time windows. Therefore, size of pre-treatment penumbra and response to reperfusion therapies, especially endovascular thrombectomy, would vary depending on time from symptom onset and rate of infarct growth, resulting in patient-specific time-windows to intervene. While rapid progressors could benefit from reperfusion therapy during very early time-window, the slow progressors can potentially benefit from treatment in either early- or late-windows This concept has been tested in the recent early- and late-window thrombolysis and thrombectomy trials. Therefore, early distinction between rapid vs slow progressor might prove particularly useful in making time-sensitive decisions, especially interfacility transfer decisions, typically between more peripheral primary stroke centers to larger endovascular therapy capable centers.
The variability in infarct growth is determined by multiple demographic, clinical, and imaging factors, such as age, blood pressure, blood glucose, stroke severity, initial infarct size, and time from ictus; these factors can influence “final” infarct volume and determine functional outcomes. Collateral blood flow status plays an especially major role in providing residual flow, and infarct size. Whether these same factors also underlie “early” infarct growth is less well studied. In the present study, the authors investigated clinical and imaging factors associated with early (hyperacute) infarct growth.