Analysis of the risk factors of the infarct growth rate in acute anterior circulation large vessel occlusion

doi:10.3969/j.issn.1006-7795.2025.04.016

Abstract

Abstract: Objective To investigate the risk factors of the infarct growth rate (IGR) in patients with acute anterior circulation large vessel occlusion. Methods This is a retrospective analysis of consecutive patients having acute anterior circulation large-vessel occlusion and being admitted to the Department of Neurointerventional Intervention, Central Hospital affiliated to Dalian University of Technology between September 2021 and July 2023. Patients were dichotomized into rapid and slow growth groups based on the median value of IGR, with 145 cases in each group. Univariate and multivariate Logistic regression models were used to analyze the risk factors of preoperative IGR. Results Multivariable Logistic regression analysis, after univariate screening, showed that hypertension (OR=2.27, 95% CI: 1.39-3.71), atrial fibrillation (OR=1.95, 95% CI: 1.22-3.12), and intracranial internal carotid artery occlusion (OR=1.98, 95% CI: 1.19-3.28) were risk factors of preoperative IGR (P<0.05). Hypertension, atrial fibrillation, and internal carotid artery occlusion all exhibited relatively low predictive value for IGR (P<0.05). The area under the curve for predicting IGR by combining these three factors was 0.642 (95% CI: 0.579-0.704), indicating a slight improvement in predictive performance, yet it remained relatively low. Conclusion Hypertension, atrial fibrillation, and proximal occlusion are risk factors of IGR in patients having acute anterior circulation large vessel occlusion.

Key words: large vessel occlusion, cerebral infarction, infarct growth rate, risk factor, hypertension, atrial fibrillation, internal carotid artery occlusion

CLC Number:

R543

Zhang Xiaowen, Tang Tao, Li Di, Li Shen, Xi Chunjiang. Analysis of the risk factors of the infarct growth rate in acute anterior circulation large vessel occlusion[J]. Journal of Capital Medical University, 2025, 46(4): 688-693.

References

［1］Berkhemer O A, Fransen P S, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke［J］. N Engl J Med, 2015, 372(1): 11－20.
［2］Campbell B C, Mitchell P J, Kleinig T J, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection［J］. N Engl J Med, 2015, 372(11): 1009－1018.
［3］Goyal M, Demchuk A M, Menon B K, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke［J］. N Engl J Med, 2015, 372(11): 1019－1030.
［4］Saver J L, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke［J］. N Engl J Med, 2015, 372(24): 2285－2295.
［5］Jovin T G, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke［J］. N Engl J Med, 2015, 372(24): 2296－2306.
［6］Nie X, Leng X, Miao Z, et al. Clinically ineffective reperfusion after endovascular therapy in acute ischemic stroke［J］. Stroke, 2023, 54(3): 873－881.
［7］Lin L, Yang J, Chen C, et al. Association of collateral status and ischemic core growth in patients with acute ischemic stroke［J］. Neurology, 2021, 96(2): e161-e170.
［8］Zaidi S F, Aghaebrahim A, Urra X, et al. Final infarct volume is a stronger predictor of outcome than recanalization in patients with proximal middle cerebral artery occlusion treated with endovascular therapy［J］. Stroke, 2012, 43(12): 3238－3244.
［9］Albers G W, Goyal M, Jahan R, et al. Relationships between imaging assessments and outcomes in solitaire with the intention for thrombectomy as primary endovascular treatment for acute ischemic stroke［J］. Stroke, 2015, 46(10): 2786－2794.
［10］Albers G W. Late window paradox［J］. Stroke, 2018, 49(3): 768－771.
［11］Xie Y, Oppenheim C, Guillemin F, et al. Pretreatment lesional volume impacts clinical outcome and thrombectomy efficacy［J］. Ann Neurol, 2018, 83(1): 178－185.
［12］Seo W K, Liebeskind D S, Yoo B, et al. Predictors and functional outcomes of fast, intermediate, and slow progression among patients with acute ischemic stroke［J］. Stroke, 2020, 51(8): 2553－2557.
［13］霍晓川, 高峰. 急性缺血性卒中血管内治疗中国指南2023［J］. 中国卒中杂志, 2023, 18(06): 684－711.
［14］Munsch F, Planes D, Fukutomi H, et al. Dynamic evolution of infarct volumes at MRI in ischemic stroke due to large vessel occlusion［J］. Neurology, 2024, 102(12): e209427.
［15］Marnat G, Kaesmacher J, Buetikofer L, et al. Interaction between intravenous thrombolysis and clinical outcome between slow and fast progressors undergoing mechanical thrombectomy: a post-hoc analysis of the SWIFT-DIRECT trial［J］. J Neurointerv Surg, 2023, 16(1): 45－52.
［16］中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018［J］. 中华神经科杂志, 2018, 51(9): 666－682.
［17］中国卒中学会,中国卒中学会神经介入分会,中华预防医学会卒中预防与控制专业委员会介入学组. 急性缺血性卒中血管内治疗影像评估中国专家共识［J］. 中国卒中杂志, 2017, 12(11): 1041－1056.
［18］Campbell B C, Christensen S, Levi C R, et al. Cerebral blood flow is the optimal CT perfusion parameter for assessing infarct core［J］. Stroke, 2011, 42(12): 3435－3440.
［19］中华医学会急诊医学分会, 急性缺血性脑卒中侧支循环评估与干预中国急诊专家共识组. 急性缺血性脑卒中侧支循环评估与干预中国急诊专家共识［J］. 中华急诊医学杂志, 2022, 31(10): 1310－1318.［20］刘天, 刘媛媛. 大动脉粥样硬化型脑梗死患者颅内血管侧支循环影响因素的研究［J］. 中华老年心脑血管病杂志, 2020, 22(7): 762－763.
［21］Giray S, Ozdemir O, Baş D F, et al. Does stroke etiology play a role in predicting outcome of acute stroke patients who underwent endovascular treatment with stent retrievers?［J］. J Neurol Sci, 2017, 372: 104－109.
［22］Dankbaar J W, Kerckhoffs K G P, Horsch A D, et al. Internal carotid artery stenosis and collateral recruitment in stroke patients［J］. Clin Neuroradiol, 2018, 28(3): 339－344.
［23］Mistry E A, Mistry A M, Nakawah M O, et al. Mechanical thrombectomy outcomes with and without intravenous thrombolysis in stroke patients: a meta-analysis［J］. Stroke, 2017, 48(9): 2450－2456.
［24］Bellwald S, Weber R, Dobrocky T, et al. Direct mechanical intervention versus bridging therapy in stroke patients eligible for intravenous thrombolysis: a pooled analysis of 2 registries［J］. Stroke, 2017, 48(12): 3282－3288.
［25］Gamba M, Gilberti N, Premi E, et al. Intravenous fibrinolysis plus endovascular thrombectomy versus direct endovascular thrombectomy for anterior circulation acute ischemic stroke: clinical and infarct volume results［J］. BMC Neurol, 2019, 19(1): 103.

[1]	Jiao Jian, Wang Xiaoqi, Shao Feng, Yuan Dan, Li Zhongxin . A study on the correlation between serum visfatin and coronary artery calcification in maintenance hemodialysis patients [J]. Journal of Capital Medical University, 2024, 45(6): 1095-1099.
[2]	Zhang Jun, Li Jie, Wang Jing, Hua Lin, Zhang Liming. Clinical analysis of eosinophilic granulomatosis with polyangiitis in elderly patientsZhang Jun1， Li Jie1， Wang Jing1， Hua Lin2, Zhang Liming1* [J]. Journal of Capital Medical University, 2024, 45(3): 515-523.
[3]	Tuo Lin, Bao Xiaoyuan. A risk model to predict the in-hospital mortality of subarachnoid hemorrhage [J]. Journal of Capital Medical University, 2024, 45(2): 348-355.
[4]	Ma Wei, Zhou Yifan, Jiang Huimin, Wei Huimin, Zhou Chen, Ji Xunming. Research progresses in cerebral venous sinus thrombosis animal models [J]. Journal of Capital Medical University, 2023, 44(5): 704-714.
[5]	Gao Xia, Hu Yanjin, Yao Zhi, Wang Guang. Correlation between triglyceride glucose index and severity of coronary artery disease in patients with newly diagnosed coronary heart disease [J]. Journal of Capital Medical University, 2023, 44(3): 381-386.
[6]	Li Jie, Zhang Jun, Wang Jing, Hua Lin, Zhang Liming. Clinical analysis of renal involvement in eosinophilic granulomatosis with polyangiitis [J]. Journal of Capital Medical University, 2023, 44(3): 494-500.
[7]	Xu Jianke, Liu Ning, Han Miao, Zhang Hongyang, Han Xinsheng. Analysis of the relationship between non-high-density lipoprotein cholesterol and arterial plaque characteristic in a cohort of ischemic stroke patients [J]. Journal of Capital Medical University, 2023, 44(1): 49-53.
[8]	Ning Bin, Zhang Dong, Wang Lishu, Jin Jin, Gan Yuyang, Song Haiman, Yu Tengfei, He Wen. A study on the diversity ultrasonographic manifestations of carotid web: compared with histopathology [J]. Journal of Capital Medical University, 2019, 40(6): 824-828.
[9]	Pan Lili, Du Juan, Ren Yanlong, Liu Wenxian. Clinical manifestation in Takayasu arteritis patients with history of tuberculosis [J]. Journal of Capital Medical University, 2019, 40(4): 621-626.
[10]	Qi Xianmei, Wang Lei, Zhang Ruiheng, Liu Ting, Liu Jie, Yang Ting, Wang Jun, Zhang Zhifei, Wang Chen. Rapeutic effect of MCC950 on monocrotaline induced rat pulmonary arterial hypertension and mechanism [J]. Journal of Capital Medical University, 2018, 39(6): 871-876.
[11]	Xu Qing, Liu Lina, Song Yanting, Qu Aijuan. Assessing stiffness of carotid artery via two-dimensional speckle-tracking in mice [J]. Journal of Capital Medical University, 2018, 39(6): 883-888.
[12]	Li Shuang, Wang Wei, Hong Hui, Zhao Lu, Wang yanling. Relationship between branch retinal vein occlusion and internal carotid artery elasticity [J]. Journal of Capital Medical University, 2017, 38(1): 6-10.
[13]	Zhang Xin, Liu Yuan, Ge Jianli, Song Yihua, Ma Yunlong, Li Xiaodong. Experimental study of Qi Huang Ju Yu Fang on rat limb arterial occlusive disease [J]. Journal of Capital Medical University, 2016, 37(3): 352-355.
[14]	Wang Dezhao, Ma Ning, Hu Hongyu, Mo Dapeng, Fu Qiang, Chen Wei, Jiang Guiying, Miao Zhongrong, Chen Buxing. Relationship between the lesions of coronary artery and the upper-aortic arteries stenosis [J]. Journal of Capital Medical University, 2016, 37(1): 58-61.
[15]	Xu Fengbo, Sun Yi, Wang Yinna, Cheng Hao. Analysis of related factors of coronary artery calcification in maintenance hemodialysis patients [J]. Journal of Capital Medical University, 2015, 36(4): 630-633.