Clinical Characteristics of Fast and Slow Progressors of Infarct Growth in Anterior Circulation Large Vessel Occlusion Stroke (5388)

Objective: To determine clinical variables associated with fast or slow progressors of early infarct growth in anterior circulation large vessel occlusion (ACLVO) stroke. Background: Fast and slow progressors are phenotypes of ischemic tolerance to ACLVO stroke that are observed in practice but remain poorly understood. Design/Methods: Single-center retrospective study of patients with intracranial ICA or MCA occlusion, with or without tandem cervical ICA occlusion, who underwent baseline CT perfusion or MRI within 24 hours of stroke onset. Fast progressors (ischemic core > 70 ml, 6 to 24 hours of stroke onset) were identified. Demographics, co-morbidities, admission NIHSS and ACLVO subtypes were tested in univariate and multivariate analysis for association with fast or slow progressor phenotype. Results: 185 patients were included with mean age 71 ± 15 and NIHSS 17 ± 7; 60% were female. Patients had occlusion of the MCA in 72% or the intracranial ICA in 28% of cases, of which 20% had tandem cervical ICA occlusion. In the early epoch, there were no significant differences in age, sex, NIHSS, co-morbidities or ACLVO subtype between fast progressors (n=19) versus controls (n=56). In the delayed epoch, mean NIHSS was 14 ± 6 in slow progressors (n=61) versus 19 ± 7 in controls (n=49). Slow progressors had MCA occlusion in 80% versus 63% (p Conclusions: Slow progressors had greater frequency of MCA occlusion and absence of tandem ICA occlusion relative to non-slow progressors. However, only age and NIHSS were independently associated with slow infarct progression in late presenting patients. Disclosure: Dr. Rocha has nothing to disclose. Dr. Desai has nothing to disclose. Dr. Jadhav has nothing to disclose. Dr. Jovin has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Stryker Neurovascular, Anaconda, FreeOx Biotech,Route92, and Blockade Medical.