Evaluate if Early Infarct Growth Rate (EIGR) can be used to predict outcome in telestroke patients treated with IV thrombolysis.

CT Perfusion (CTP) can aid in thrombectomy decision making in patients with acute ischemic stroke. Fast progressors defined by EIGR have been correlated with worse outcomes after thrombectomy.

We retrospectively analyzed consecutive telestroke patients with a baseline modified Rankin Scale score (mRS) ≤2 and received CTP prior to IV thrombolysis, between July 2019 and June 2021. We compared outcomes of fast (EIGR ≥10mL/h) versus slow (EIGR <10mL/h) progressors treated with thrombolysis.  Primary efficacy and safety outcomes were: functional independence at 90 days (mRS 0–2) and major hemorrhage ≤36h post-thrombolysis.  Secondary outcomes included excellent functional recovery (mRS 0–1), and death at 90 days.  Primary and secondary outcomes were analyzed using multivariable binary logistic regression models in two blocks.  The first block proceeded by stepwise fashion and included possible confounding variables as determined by univariate analyses and prior research, followed by the variable of interest: EIGR (<10ml/h; ≥10mL/h).

There were 2767 telestroke consults during the study period and 261 (9.4%) were treated with IV thrombolysis. A total of 146 patients had baseline mRS ≤2, received CTP prior to IV thrombolysis and were included in this study. Fast progressors were less likely to attain functional independence at 90 days compared to slow progressors [7(41.2%) vs 109(84.5%)], adjusted odds ratio (aOR)=0.22 [95%CI, 0.06–0.85], p=0.03,  but no difference in major hemorrhage rate between fast and slow progressors, [1(5.9%) vs 2(1.6%)], p=0.48.  Fast progressors had lower rates of excellent functional recovery, [5(31.3%) vs 94(78.3%)], aOR=0.15 [95%CI, 0.04–0.58], p=0.006, and higher rates of death at 90 days, [4(23.5%) vs 4(3.1%)], aOR=9.62 [95%CI, 2.15–43.05], p=0.003.

IV Thrombolysis treated telestroke patients defined by EIGR as fast progressors had worse outcomes at 90 days.