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Introduction <p>Infarct growth rate (IGR) is highly heterogeneous among ischemic stroke patients, reflecting a spectrum of progressor phenotypes with clinical implications. We aim to compare different imaging approaches to investigate stroke progressors phenotypes and their clinical implications in patients undergoing thrombectomy.</p> Methods <p>Data are from the prospective Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS). Patients with M1/M2 occlusion and known symptom onset were included. Progressor phenotypes were defined using (1) NCCT-based definitions (ASPECTS points decay per hour &lt; 0.25 pts/h=slow progressor, 0.25–0.50 pts/h=intermediate, and &gt; 0.50 pts/h=fast); and (2) CTP-based definitions (CTP-estimated core divided by time of onset &lt; 5 mL/h=slow progressors, 5–10mL/h=intermediate, and &gt; 10 mL/h=fast). The primary outcome was 90-day good functional outcome (modified Rankin Scale [mRS] = 0–2). Associations were assessed with logistic regression analyses adjusted for age, sex, NIHSS, TICI score, thrombolysis, and imaging-to-recanalization time.</p> Results <p>Of 26799 patients screened, 8322 (31.1%) were included (NCCT group: 8076; CTP group: 897 patients). NCCT-based progressor phenotype was associated with lower odds of good outcome (aOR 0.82 [95%CI = 0.72–0.92] per each progressor phenotype increase). ASPECTS decay per hour was associated with lower odds of good outcome (acOR 0.94 [95%CI = 0.89–0.99]). No significant association was observed for either CTP-based progressor phenotype or CTP-based IGR (mL/h). Similar findings were observed for secondary outcomes.</p> Conclusions <p>In this large, real-world cohort of stroke patients, NCCT-based IGR was associated with functional outcomes, whereas CTP-based IGR was not. This highlights the need to refine and identify more accurate markers of infarct growth within perfusion imaging.</p>

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Clinical Implications of Stroke Progressor Phenotypes defined based on ASPECTS decay and perfusion estimated infarct growth rate: insights from a large national thrombectomy registry

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  • 发表日期：

    2026年6月16日

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  • Antonio Ciacciarelli,
  • Ettore Nicolini,
  • Valentina Saia,
  • Giovanni Pracucci,
  • Umberto Pensato,
  • Manuela De Michele,
  • Lorenzo Benedetti,
  • Ilaria Casetta,
  • Enrico Fainardi,
  • Simona Marcheselli,
  • Valerio Da Ros,
  • Ilaria Maestrini,
  • Luigi Simonetti,
  • Andrea Zini,
  • Sergio Lucio Vinci,
  • Paolino La Spina,
  • Antonio Laiso,
  • Patrizia Nencini,
  • Bruno Del Sette,
  • Tiziana Benzi Markushi,
  • Sandra Bracco,
  • Rossana Tassi,
  • Andrea Saletti,
  • Alessandro De Vito,
  • Andrea Boghi,
  • Andrea Naldi,
  • Nicola Burdi,
  • Giovanni Boero,
  • Stefano Vallone,
  • Guido Bigliardi,
  • Guido Andrea Lazzarotti,
  • Nicola Giannini,
  • Nicola Milazzo,
  • Alessandra Persico,
  • Maria Ruggiero,
  • Marco Longoni,
  • Roberto Menozzi,
  • Alessandro Pezzini,
  • Luca Allegretti,
  • Tiziana Tassinari,
  • Francesca Mambrin,
  • Manuel Cappellari,
  • Mauro Bergui,
  • Giovanni Bosco,
  • Alessio Comai,
  • Enrica Franchini,
  • Emilio Lozupone,
  • Marcella Caggiula,
  • Sergio Zimatore,
  • Marco Petruzzellis,
  • Ivan Gallesio,
  • Delfina Ferrandi,
  • Marco Perri,
  • Federica De Santis,
  • Edoardo Puglielli,
  • Alfonsina Casalena,
  • Gianluca Galvano,
  • Eleonora Saracco,
  • Massimiliano Allegritti,
  • Stefano Caproni,
  • Matteo Alberti,
  • Paolo Invernizzi,
  • Giuseppe Carità,
  • Monia Russo,
  • Michele Besana,
  • Alessia Giossi,
  • Marco Filizzolo,
  • Marina Mannino,
  • Giuseppe Pelle,
  • Michele Alessiani,
  • Daniel Konda,
  • Fabrizio Sallustio,
  • Salvatore Mangiafico,
  • Danilo Toni

摘要

Introduction

Infarct growth rate (IGR) is highly heterogeneous among ischemic stroke patients, reflecting a spectrum of progressor phenotypes with clinical implications. We aim to compare different imaging approaches to investigate stroke progressors phenotypes and their clinical implications in patients undergoing thrombectomy.

Methods

Data are from the prospective Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS). Patients with M1/M2 occlusion and known symptom onset were included. Progressor phenotypes were defined using (1) NCCT-based definitions (ASPECTS points decay per hour < 0.25 pts/h=slow progressor, 0.25–0.50 pts/h=intermediate, and > 0.50 pts/h=fast); and (2) CTP-based definitions (CTP-estimated core divided by time of onset < 5 mL/h=slow progressors, 5–10mL/h=intermediate, and > 10 mL/h=fast). The primary outcome was 90-day good functional outcome (modified Rankin Scale [mRS] = 0–2). Associations were assessed with logistic regression analyses adjusted for age, sex, NIHSS, TICI score, thrombolysis, and imaging-to-recanalization time.

Results

Of 26799 patients screened, 8322 (31.1%) were included (NCCT group: 8076; CTP group: 897 patients). NCCT-based progressor phenotype was associated with lower odds of good outcome (aOR 0.82 [95%CI = 0.72–0.92] per each progressor phenotype increase). ASPECTS decay per hour was associated with lower odds of good outcome (acOR 0.94 [95%CI = 0.89–0.99]). No significant association was observed for either CTP-based progressor phenotype or CTP-based IGR (mL/h). Similar findings were observed for secondary outcomes.

Conclusions

In this large, real-world cohort of stroke patients, NCCT-based IGR was associated with functional outcomes, whereas CTP-based IGR was not. This highlights the need to refine and identify more accurate markers of infarct growth within perfusion imaging.