Infarct core Growth Rate and 90-Day Outcomes in Ischemic Stroke: Subgroup Analysis Based on Onset-to-Recanalization Time

Sha Chen ¹ Guofang Chen ² Changzhi Zhao ¹ Enle Wang ³ Yewen Zhou ³ Manhua Ding ^4* Yang Zhang ^1,2,5*

• ¹ The Affiliated Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
• ² Department of Neurology, Xuzhou Central Hospital, Xuzhou, China
• ³ Southeast University School of Medicine，Southeast University School, Nanjing, China
• ⁴ Department of Radiotherapy, Xuzhou Cancer Hospital, Xuzhou, Jiangsu Province, China
• ⁵ Department of Neurology and Clinical Research Center of Neurological Disease, The Second Afliated Hospital of Soochow University, Suzhou, China

Background: It is essential to understand the factors that influence patient outcomes in stroke research. The infarct core growth rate (ICGR) is a promising marker, but its relationship with patient outcomes, particularly the onset-to-recanalization time (ORT), requires further clarification. This study investigates the impact of ICGR on 90-day (90d) outcomes in acute ischemic stroke patients and explores whether stratifying ICGR analysis based on ORT provides more detailed prognostic insights.Methods: This study retrospectively analyzed patients with acute ischemic stroke with anterior circulation large vessel occlusion (AIS-ACLVO) who underwent endovascular treatment (EVT) between January 2021 and December 2023. Their clinical characteristics, baseline and imaging data were recorded upon admission. Clinical outcomes were evaluated using the modified Rankin Scale (mRS) at 90 days post-procedure. The least absolute shrinkage and selection operator (LASSO) regression was employed for data screening. Multivariable logistic regression analysis was performed to explore the relationship between ICGR and 90-day (90d) clinical outcome. Additionally, a stratified analysis based on ORT was conducted to compare the diagnostic performance of ICGR and infarct core volume (ICV) at different time points.Results: A total of 153 patients were included in the analysis. Univariate and Lasso regression analyses showed that the group with unfavorable outcomes had statistically significant differences in ICGR, age, history of atrial fibrillation, history of drinking, admission blood glucose level, Alberta Stroke Program Early CT Score (ASPECTS), and National Institutes of Health Stroke Scale (NIHSS) score compared to the favorable outcome group (all P<0.05). Furthermore, multivariate logistic regression analysis indicated that ICGR was independently associated with clinical outcome in AIS-ACLVO patients [Odds Ratio (OR) 1.101, 95% confidence interval (CI) 1.029-1.178; P=0.005]. When stratified by median ORT, the ICGR remained a strong predictor of outcome within 8 hours (OR 1.188, 95% CI 1.048-1.347; P=0.007), and proved to be a better predictor than ICV [area under the Receiver Operating Characteristic (AUROC) curve, 0.816 vs 0.750, P=0.024)].Conclusions: Our research indicates that the ICGR correlates with 90d clinical outcomes in AIS-ACLVO patients: a faster rate is associated with poorer outcomes. Within 8 hours of ORT, the ICGR serves as a better predictor of 90d outcome than ICV.