Background and Purpose:We aimed to delineate the determinants of the initial speed of infarct progression and the association of speed of infarct progression (SIP) with procedural and functional outcomes.Methods:From a prospectively maintained stroke center registry, consecutive anterior circulation ischemic stroke patients with large artery occlusion, National Institutes of Health Stroke Scale score ≥4, and multimodal vessel, ischemic core, and tissue-at-risk imaging within 24 hours of onset were included. Initial SIP was calculated as ischemic core volume at first imaging divided by the time from stroke onset to imaging.Results:Among the 88 patients, SIP was median 2.2 cc/h (interquartile range, 0–8.7), ranging most widely within the first 6 hours after onset. Faster SIP was positively independently associated with a low collateral score (odds ratio [OR], 3.30 [95% CI, 1.25–10.49]) and arrival by emergency medical services (OR, 3.34 [95% CI, 1.06–10.49]) and negatively associated with prior ischemic stroke (OR, 0.12 [95% CI, 0.03–0.50]) and coronary artery disease (OR, 0.32 [95% CI, 0.10–1.00]). Among the 67 patients who underwent endovascular thrombectomy, slower SIP was associated with a shift to reduced levels of disability at discharge (OR, 3.26 [95% CI, 1.02–10.45]), increased substantial reperfusion by thrombectomy (OR, 8.30 [95% CI, 0.97–70.87]), and reduced radiological hemorrhagic transformation (OR, 0.34 [95% CI, 0.12–0.94]).Conclusions:Slower SIP is associated with a high collateral score, prior ischemic stroke, and coronary artery disease, supporting roles for both collateral robustness and ischemic preconditioning in fostering tissue resilience to ischemia. Among patients undergoing endovascular thrombectomy, the speed of infarct progression is a major determinant of clinical outcome.

中文翻译：

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急性缺血性卒中患者快速，中度和缓慢进展的预测指标和功能结果。

背景与目的：我们旨在确定梗塞进展的初始速度以及梗塞进展速度（SIP）与手术和功能结局之间的关系的决定因素。方法：从前瞻性维持的卒中中心登记资料中，连续性前循环缺血性卒中患者包括大动脉闭塞，美国国立卫生研究院卒中量表评分≥4，以及多发性血管，缺血性核心和发病后24小时内的有组织危险的影像学。结果：在88例患者中，SIP的中位数为2.2 cc / h（四分位数范围为0-8.7），在第一次成像中的范围最广。发病后6小时。较快的SIP与低抵押品得分（优势比[OR]，3.30 [95％CI，1.25-10.49]）和急诊医疗服务的到达率（OR，3.34 [95％CI，1.06-10.49]）呈正相关独立关系。与先前的缺血性卒中（OR，0.12 [95％CI，0.03-0.50]）和冠状动脉疾病（OR，0.32 [95％CI，0.10-1.00]）负相关。在接受血管内血栓切除术的67例患者中，SIP减慢与出院时残疾水平降低有关（OR，3.26 [95％CI，1.02–10.45]），血栓切除术对实质性再灌注的增加（OR，8.30 [95％]）。 CI，0.97–70.87]），放射线出血性转化率降低（OR，0.34 [95％CI，0.12–0.94]）。结论：SIP降低与侧支评分高，缺血性卒中和冠心病相关，在增强组织对局部缺血的抵抗力方面，对侧支健壮性和局部缺血预处理的支持作用。在接受血管内血栓切除术的患者中，梗塞进展的速度是临床结果的主要决定因素。