Characteristics and outcomes of fast progressors receiving endovascular treatment for acute large vessel occlusion: a systematic review and meta-analysis.

Abstract

Background Acute large vessel occlusion patients can be categorized into fast and slow progressors based on infarction growth rate (IGR) before endovascular treatment (EVT). However, the characteristics of fast progressors remain uncertain, and a comprehensive review investigating the adverse effects of fast IGR is needed. Methods A systematic search of studies published before March 24, 2025 was conducted using PubMed, Web of Science, Embase, and Cochrane Library following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Studies comparing fast and slow progressors before EVT were screened. Baseline characteristics and clinical outcomes were collected. Meta-analysis was performed to pool the results. Weighted odds ratio (OR), mean difference (MD), and confidence intervals (CI) were calculated. This study was registered on the International Prospective Register of Systematic Reviews platform (CRD420251016945). Results A total of 8 studies involving 2718 patients were pooled. Age and gender were similar between fast and slow progressors. Fast progressors had significantly higher baseline National Institute of Health Stroke Scale scores (MD, 2.7; 95%CI, 2.0-3.4; I2=0), higher intravenous thrombolysis rates (OR, 1.41; 95%CI, 1.07-1.86; I2=62%), larger proportions of internal carotid artery occlusion (OR, 1.74; 95%CI, 1.39-2.19; I2=0), and lower percentages of good collateral status (OR, 0.33; 95%CI, 0.22-0.50; I2=53%). Cardioembolism etiology was also prevalent in fast progressors (OR, 1.42; 95%CI, 1.10-1.83; I2=0). Regarding outcomes, fast IGR was associated with significantly lower rates of successful reperfusion (OR, 0.70; 95%CI, 0.57-0.86; I2=0) and modified Rankin Scale (mRS) score 0-2 at 90-day (OR, 0.34; 95%CI, 0.28-0.42; I2=0). Meanwhile, the proportions of symptomatic intracranial hemorrhage (OR, 3.54; 95%CI, 1.78-7.01; I2=33%) and 90-day mRS scores (MD, 0.94; 95%CI, 0.61-1.26; I2=51%) were higher in fast progressors. Conclusion Increased stroke severity, proximal vessel occlusion, worse collateral status, and cardioembolism etiology were key features of fast progressors before EVT. Fast progressors exhibit significantly elevated risks of poor outcomes. Taking IGR into consideration during clinical practice and research is essential.