To determine clinical variables associated with fast or slow progressors of early infarct growth in anterior circulation large vessel occlusion (ACLVO) stroke.

Single-center retrospective study of patients with intracranial ICA or MCA occlusion, with or without tandem cervical ICA occlusion, who underwent baseline CT perfusion or MRI within 24 hours of stroke onset.  Fast progressors (ischemic core > 70 ml, < 6 hours of stroke onset) and slow progressors (ischemic core ≤ 30 ml, > 6 to 24 hours of stroke onset) were identified.   Demographics, co-morbidities, admission NIHSS and ACLVO subtypes were tested in univariate and multivariate analysis for association with fast or slow progressor phenotype.

185 patients were included with mean age 71 ± 15 and NIHSS 17 ± 7; 60% were female.  Patients had occlusion of the MCA in 72% or the intracranial ICA in 28% of cases, of which 20% had tandem cervical ICA occlusion. In the early epoch, there were no significant differences in age, sex, NIHSS, co-morbidities or ACLVO subtype between fast progressors (n=19) versus controls (n=56).  In the delayed epoch, mean NIHSS was 14 ± 6 in slow progressors (n=61) versus 19 ± 7 in controls (n=49).  Slow progressors had MCA occlusion in 80% versus 63% (p < 0.05) and tandem occlusion in 10% versus 35% of controls (p < 0.01).  Multivariate regression showed that age (OR 1.04, 95% CI  1.01-1.07) and NIHSS (OR 0.87, 95% CI 0.81-0.93) but not ACLVO subtype were independently associated with slow progressor status.