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Abstract：
Background Acute ischemic stroke, particularly in cases involving large vessel occlusion (LVO), poses a significant challenge due to the potential for rapid infarct expansion in the early phase. Such expansion, if not managed promptly, can lead to severe neurological deficits and poor clinical outcomes. Understanding the contributing factors that accelerate early infarct expansion is crucial for optimizing treatment strategies and improving patient prognosis. The main aim of the study is to determine the factors contributing to rapid early infarct expansion in acute ischemic stroke patients with LVO. Methodology The retrospective study was conducted at Liaquat National Hospital in Karachi from August 2023 to December 2023. Data were collected from 685 patients with anterior circulation LVO-related acute stroke with witnessed stroke onset and baseline perfusion imaging. Extracted clinical data included age, gender, medical history (hypertension, diabetes, etc.), and baseline National Institutes of Health Stroke Scale (NIHSS) scores. Results The mean age of the included patients was 67.4 years, with a relatively balanced gender distribution, i.e., 48.5% male (n = 332) and 51.5% female (n = 353). The mean baseline NIHSS score was 14.2, reflecting initial neurological severity. Imaging parameters revealed that 294 (42.6%) patients exhibited infarct expansion, with an average penumbra size of 23.5 mL. Hypoperfusion intensity ratio (HIR) quartiles demonstrated a notable association with progression rates, escalating from 27 (4%) patients in the first quartile to approximately 527 (77%) patients in the fourth quartile, highlighting a significant correlation between HIR and infarct expansion (p < 0.001). Conclusions HIR emerged as a pivotal factor strongly associated with rapid infarct expansion, underscoring its significance in predicting the trajectory of ischemic injury.
摘要：
背景急性缺血性卒中,特别是在涉及大血管闭塞（LVO）的情况下，由于早期梗死迅速扩张的可能性，因此提出了重大挑战。这样的扩张,如果不及时管理，可导致严重的神经功能缺损和不良的临床结果。了解加速早期梗死扩展的因素对于优化治疗策略和改善患者预后至关重要。该研究的主要目的是确定导致LVO急性缺血性卒中患者早期梗死迅速扩大的因素。方法回顾性研究于2023年8月至2023年12月在卡拉奇的Liaquat国家医院进行。收集了685例前循环LVO相关急性卒中患者的数据，见证了卒中发作和基线灌注成像。提取的临床数据包括年龄，性别,病史（高血压，糖尿病,等。),和基线美国国立卫生研究院卒中量表（NIHSS）评分。结果纳入患者的平均年龄为67.4岁,性别分布相对均衡，即，48.5%男性(n=332)和51.5%女性(n=353)。平均基线NIHSS评分为14.2，反映了最初的神经系统严重程度。影像学参数显示294例(42.6%)患者出现梗死灶扩张,平均半影大小为23.5毫升。低灌注强度比（HIR）四分位数与进展率显著相关，从第一个四分位数的27名（4％）患者升级到第四个四分位数的大约527名（77％）患者，强调了HIR和梗死灶扩大之间的显著相关性(p<0.001)。结论HIR是与梗死灶快速扩张密切相关的关键因素,强调其在预测缺血性损伤轨迹中的意义。
