Cerebral Infarct Growth: Pathophysiology, Pragmatic Assessment, and Clinical Implications

半影 医学 心脏病学 冲程(发动机) 内科学 梗塞 缺血 脑血流 病理生理学 灌注 灌注扫描 闭塞 放射科 心肌梗塞 机械工程 工程类
作者
Umberto Pensato,Andrew M. Demchuk,Bijoy K. Menon,Thanh N. Nguyen,Gabriel Broocks,Bruce Campbell,Diego Vásquez,Peter Mitchell,Michael D. Hill,Mayank Goyal,Johanna M. Ospel
出处
期刊:Stroke [Lippincott Williams & Wilkins]
卷期号:56 (1): 219-229 被引量:5
标识
DOI:10.1161/strokeaha.124.049013
摘要

Cerebral ischemic injury occurs when blood flow drops below a critical level, resulting in an energy failure. The progressive transformation of hypoperfused viable tissue, the ischemic penumbra, into infarction is a mechanism shared by patients with ischemic stroke if timely reperfusion is not achieved. Yet, the pace at which this transformation occurs, known as the infarct growth rate (IGR), exhibits remarkable heterogeneity among patients, brain regions, and over time, reflecting differences in compensatory collateral flow and ischemic tolerance. We review (1) the pathophysiology of infarct growth, (2) the advantages and pitfalls of different approaches of IGR measurement, (3) research gaps for future studies, and (4) the clinical implications of stroke progressor phenotypes. The estimated average IGR in patients with acute large vessel occlusion stroke is 5.4 mL/h although there is wide variability based on ischemic stroke subtype, occlusion location, presence of collaterals, and patient baseline status. The IGR can be calculated using various pragmatic strategies, mostly either quantifying the extension of the infarct at a particular time and dividing this measure by the time that elapsed from symptom onset to imaging assessment or by using collateral blood flow status as a radiological surrogate marker. The IGR defines a spectrum of clinical stroke phenotypes, often dichotomized into fast and slow progressors. An IGR ≥10 mL/h and the perfusion metric hypoperfusion intensity ratio ≥0.5 are commonly used definitions of fast progressors. A nuanced understanding of the IGR and stroke progressor phenotypes could have clinical implications, including informing prognostication, acute decision-making in peripheral-to-comprehensive transfer patients eligible for thrombectomy, and selection for adjuvant neuroprotective agents.
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