How to Define Fast and Slow Progressors in Any-Type Occlusion Acute Ischemic Stroke

The variable rate of infarct progression in acute ischemic stroke as assessed by various thresholds excludes a substantial proportion of patients due to time or core constraints. We evaluated 106 patients with any-type occlusion to compare these thresholds and assessed performance of hypoperfusion index (HI) for fast and slow rate of infarct progression. Seven (12.5%) were classified fast progressors and 23 (46%), 25 (50%), 12 (24%), and 33 (66%) slow progressors using different core and time criteria. In comparison, HI categorized 100% (n = 106) of cohort with optimal cutoff 0.5 for any-type occlusion (slow progressors: HI <= 0.5), sensitivity/specificity 100%/91%, AUC 0.94, and indicative of eligibility for reperfusion and clinical outcomes (median 90-day modified Rankin Scale; 2 for HI <= 0.5 versus 5). Estimation of progressors by HI seems comprehensive but needs external validation.

Automated summary

This study evaluated the variable rate of infarct progression in acute ischemic stroke using different thresholds. It found that a substantial proportion of patients were excluded when assessed by various time or core constraints. However, the hypoperfusion index (HI) showed comprehensive evaluation of the fast and slow rate of infarct progression and provided indications for reperfusion and clinical outcomes assessment.