ABSTRACT NUMBER: ESOC2026A199 CLINICAL IMPLICATIONS OF STROKE PROGRESSOR PHENOTYPES DEFINED BASED ON ASPECTS DECAY AND PERFUSION ESTIMATED INFARCT GROWTH RATE: INSIGHTS FROM A LARGE NATIONAL THROMBECTOMY REGISTRY

Abstract Background and aims 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 NCCT-based definitions (ASPECTS points decay per hour < 0.25pts/h = slow progressor, 0.25–0.50pts/h = intermediate, and > 0.50pts/h = fast); and CTP-based definitions (CTP-estimated core divided by time of onset < 5 mL/h = slow progressors, 5–10 mL/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-based group: 897 patients). NCCT-based progressor phenotype was associated with lower odds of good outcome (adjusted OR 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-estimated IGR (mL/h). Similar findings were observed for secondary outcomes. Conclusions In this large, real-world cohort of stroke patients, NCCT-based ASPECTS decay was associated with functional outcomes, whereas CTP-based definitions were not, supporting direct visualization of ischemic changes as a more reliable marker of infarct progression. Conflict of interest The authors declare no conflicts of interest.