Clinical Implications of Stroke Progressor Phenotypes defined based on ASPECTS decay and perfusion estimated infarct growth rate: insights from a large national thrombectomy registry

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.

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Journal
Neurological Sciences
Published
2026-06-16
DOI
https://doi.org/10.1007/s10072-026-09148-4
Primary Topic
Acute Ischemic Stroke Management
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article
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article

Clinical Implications of Stroke Progressor Phenotypes defined based on ASPECTS decay and perfusion estimated infarct growth rate: insights from a large national thrombectomy registry

Ilaria Casetta, Umberto Pensato, Ilaria Maestrini, Luigi Simonetti et al.
Neurological Sciences
Acute Ischemic Stroke Management
article

Clinical Implications of Stroke Progressor Phenotypes defined based on ASPECTS decay and perfusion estimated infarct growth rate: insights from a large national thrombectomy registry

Ilaria Casetta, Umberto Pensato, Ilaria Maestrini, Luigi Simonetti, Michele Alessiani, Giuseppe Carità, Simona Marcheselli, Daniel Konda, Guido Andrea Lazzarotti, Bruno Del Sette, Andrea Zini, Ivan Gallesio, Andrea Saletti, Nicola Burdi, Francesca Mambrin, Guido Bigliardi, Delfina Ferrandi, Paolo Invernizzi, Valentina Saia, Manuela De Michele, Gianluca Galvano, Marco Perri, Alessio Comai, Ettore Nicolini, Emilio Lozupone, Andrea Naldi, Alessandra Persico, Alessandro De Vito, Nicola Giannini, Antonio Laiso, Antonio Ciacciarelli, Danilo Toni, Giuseppe Pelle, Edoardo Puglielli, Salvatore Mangiafico, Stefano Caproni, Giovanni Boero, Paolino La Spina, Fabrizio Sallustio, Massimiliano Allegritti, Marcella Caggiula, Federica De Santis, Rossana Tassi, Michele Besana, R. Menozzi, Alfonsina Casalena, Luca Allegretti, Matteo Alberti, Nicola Milazzo, Lorenzo Benedetti, Monia Russo, Enrica Franchini, Sergio Zimatore, Tiziana Benzi Markushi, Giovanni Pracucci, Marco Filizzolo, Enrico Fainardi, Patrizia Nencini, Manuel Cappellari, Marina Mannino, Alessandro Pezzini, Sergio Lucio Vinci, Tiziana Tassinari, Valerio Da Ros, Giovanni Bosco, Alessia Giossi, Andrea Boghi, Mauro Bergui, Marco Longoni, Stefano Vallone, Marco Petruzzellis, Sandra Bracco, Eleonora Saracco, Maria Ruggiero
article en

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.

Neurological SciencesVol. 47(7)
University of Messina (IT), University of Rome Tor Vergata (IT), University of Teramo (IT), Humanitas University (IT), University of Ferrara (IT), Policlinico Umberto I (IT), Istituto Neurologico Mediterraneo (IT), Azienda Unita' Sanitaria Locale Di Modena (IT), Ospedale di Bolzano (IT), Azienda Ospedaliera Universitaria Integrata Verona (IT), Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari (IT), Fondazione Istituto Neurologico Nazionale Casimiro Mondino (IT), Fondazione Ricerca Molinette (IT), AULSS 2 Marca Trevigiana (IT), Ospedale San Filippo Neri (IT), Ospedale Vincenzo Cervello (IT), Azienda Unità Sanitaria Locale di Ferrara (IT), Ospedale Garibaldi (IT), Azienda Ospedaliero-Universitaria di Modena (IT), Ospedale “M. Bufalini” di Cesena (IT), Azienda Ospedaliero-Universitaria Careggi (IT), Ospedale San Giovanni Bosco (IT), Institute of Neurological Sciences (IT), Presidio Ospedaliero (IT), Azienda Ospedaliera S.Maria (IT), Istituto delle Scienze Neurologiche di Bologna (IT), Arcispedale Sant'Anna (IT), Azienda Sanitaria Locale Alessandria (IT), Torino e-district (IT), Azienda Ospedaliera Universitaria Senese (IT), Ospedale di Parma (IT), Azienda-Unita' Sanitaria Locale Di Cesena (IT), Policlinico Tor Vergata (IT), Azienda Ospedaliera Universitaria Policlinico "G. Martino" (IT), Ospedale Santa Maria Goretti (IT), San Gallicano Hospital (IT), Ospedale Policlinico San Martino (IT), Fondazione Poliambulanza Istituto Ospedaliero (IT), Ospedale Santa Maria della Misericordia di Rovigo (IT), Ospedale SS. Annunziata (IT), Policlinico San Matteo Fondazione (IT), Ospedale Vito Fazzi (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Azienda Sanitaria Locale Roma 3 (IT), IRCCS Humanitas Research Hospital (IT), Ospedale Santa Corona (IT), Azienda Ospedaliera Universitaria Pisana (IT), Istituti Ospitalieri di Cremona (IT), Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte (IT), University of Florence (IT), University of Turin (IT), Sapienza University of Rome (IT)
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