Clinical Implications of Stroke Progressor Phenotypes defined based on ASPECTS decay and perfusion estimated infarct growth rate: insights from a large national thrombectomy registry
Year: 2026
Type: article
Study design: Observational Study
Abstract: 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.
Source: Neurological Sciences
Authors: 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
Institutions: Policlinico Umberto I, Sapienza University of Rome, Ospedale Santa Corona, University of Florence, Humanitas University, IRCCS Humanitas Research Hospital, Arcispedale Sant'Anna, Azienda Ospedaliero-Universitaria Careggi, University of Rome Tor Vergata, Policlinico Tor Vergata, Ospedale Maggiore Carlo Alberto Pizzardi, Istituto delle Scienze Neurologiche di Bologna, University of Messina, Azienda Ospedaliera Universitaria Policlinico "G. Martino", Ospedale Policlinico San Martino, Azienda Ospedaliera Universitaria Senese, University of Ferrara, Ospedale San Giovanni Bosco, Azienda Ospedaliero-Universitaria di Modena, Azienda Ospedaliera Universitaria Pisana, Policlinico San Matteo Fondazione, Fondazione Istituto Neurologico Nazionale Casimiro Mondino, Azienda-Unita' Sanitaria Locale Di Cesena, Ospedale “M. Bufalini” di Cesena, University of Parma, Ospedale di Parma, Regione Liguria, Azienda Ospedaliera Universitaria Integrata Verona, University of Turin, Ospedale di Bolzano, Azienda Sanitaria dell'Alto Adige, Ospedale Vito Fazzi, Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari, Ospedale Garibaldi, Azienda Ospedaliera S.Maria, Fondazione Poliambulanza Istituto Ospedaliero, Ospedale Santa Maria della Misericordia di Rovigo, AULSS 5 Polesana, Istituti Ospitalieri di Cremona, Azienda Socio Sanitaria Territoriale di Cremona, Ospedale Vincenzo Cervello, Ospedale Santa Maria Goretti, ASL Roma, Istituto Neurologico Mediterraneo
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,090
Funder: Sapienza Università di Roma
OpenAlex ID: W7164859996