부산대학교 도서관

Introduction:Heterogeneity of collateralization in patients with acute ischemic stroke (AIS) is a marker of fast versus slow progression of penumbral consumption and infarct expansion. Our aim was to evaluate the relationship between time-dependent stroke progression and incidence of intracranial hemorrhage (ICH) and acute neurological deficits.Methods:Retrospective chart review of patients presenting with anterior circulation large vessel occlusion (LVO)-associated AIS at our comprehensive stroke center with 24 hours last known normal (LKN) who underwent endovascular thrombectomy (EVT) without intra-arterial thrombolytics or non-thrombolytics were included. We used Alberta Stroke Program Early CT Score (ASPECTS) on initial non-contrast CT to identify slow versus fast progressors. ASPECTS <=7 was defined as fast progressor. Subgroup analysis was performed based on LKN <3 hours, 3-9 hours, and 9-24 hours. We evaluated rate of hemorrhagic transformation using ECASS-3 criteria and determined change in NIHSS from baseline to discharge. Mann-Whitney U test and Fisher exact test statistic with Social science statistics software used for data analysis.Results:From September 2019 to December 2021, out of 268 subjects who underwent EVT, 48 met inclusion criteria. Mean age was 65.29 (95% CI 61.32, 69.27), and median presenting NIHSS was 16 (95% CI 14.39, 18.40). Mean ASPECTS was 7.71 (95% CI 7.21, 8.20). There was significant difference is hemorrhagic transformation rate between ASPECTS >7 and <=7 (Fisher value=0.018). Sample size was not large enough to perform subgroup analysis based on last known normal. However, there was a trend towards increase in hemorrhagic transformation rate with greater time from last known well at same ASPECTS score. Slow progressors also had a significant improvement in presenting and discharge NIHSS as compared to fast progressors (z-score is -3.10, p-value is 0.002).Conclusion:Our study suggests that ASPECTS score as assessed in different time windows to differentiate fast versus slow progressors is not only a predictor of clinical outcome, but also independently associated with risk of hemorrhagic transformation. Larger, prospective studies are needed to validate our results.