Association of Brain Atrophy With Functional Outcome and Recovery Trajectories After Thrombectomy

Benali, Faysal; Fladt, Joachim; Jaroenngarmsamer, Tanaporn; Bala, Fouzi; Singh, Nishita; Ospel, Johanna Maria; Tymianski, Michael; Hill, Michael D.; Goyal, Mayank; Ganesh, Aravind

doi:10.1212/wnl.0000000000207700

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…35 While an important value of our article is in demonstrating how simple measurements of brain atrophy on NCCT compare with MR imaging measurements, the specific setting of acute stroke used for our study is also of interest, given the emerging recognition of atrophy and other such measures of brain frailty as important mediators of treatment outcome in acute stroke. [36][37][38] Because there is now considerable impetus for future acute stroke studies to factor such variables into the analyses, our finding that cortical and subcortical atrophy can be feasibly measured on NCCT in the acute setting is reassuring. In addition, future studies could examine how the underestimation of atrophy burden on NCCT affects the prediction of poststroke outcomes.…”

Section: Discussionmentioning

confidence: 86%

Cortical and Subcortical Brain Atrophy Assessment Using Simple Measures on NCCT Compared with MRI in Acute Stroke

Jaroenngarmsamer,

Benali,

Fladt

et al. 2023

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Brain atrophy is an important surrogate for brain reserve, the capacity of the brain to cope with acquired injuries such as acute stroke. It is unclear how well atrophy measurements on MR imaging can be reproduced using NCCT imaging. We aimed to compare pragmatic atrophy measures on NCCT with MR imaging in patients with acute ischemic stroke. MATERIALS AND METHODS:This is a post hoc analysis, including baseline NCCT and 24-hour follow-up MR imaging data from the Safety and Efficacy of Nerinetide (NA-1) in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) trial. Cortical atrophy was measured using the global cortical atrophy scale, and subcortical atrophy was measured using the intercaudate distance-to-inner-table width (CC/IT) ratio. Agreement and correlation between these measures on NCCT and MR imaging were calculated using the Gwet agreement coefficient 1 and Pearson correlation coefficients, respectively. RESULTS: Among 1105 participants in the ESCAPE-NA1 trial, interpretable NCCT and 24-hour MR imaging were available in 558 (50.5%) patients (mean age, 67.2 [SD, 13.7] years; 282 women). Cortical atrophy assessments performed on NCCT underestimated atrophy severity compared with MR imaging (eg, patients with global cortical atrophy of $1 assessed on NCCT ¼ 133/558 [23.8%] and on MR imaging ¼ 247/558 [44.3%]; a 20.5% difference). Overall, cortical (ie, global cortical atrophy) atrophy assessments on NCCT had substantial or better agreement with MR imaging (Gwet agreement coefficient 1 of . 0.784; P , .001). Subcortical atrophy measures (CC/IT ratio) showed strong correlations between NCCT and MR imaging (Pearson correlation ¼ 0.746, P , .001).CONCLUSIONS: Brain atrophy can be evaluated using simple measures in emergently acquired NCCT. Subcortical atrophy assessments on NCCT show strong correlations with MR imaging. Although cortical atrophy assessments on NCCT are strongly correlated with MR imaging ratings, there is a general underestimation of atrophy severity on NCCT. ABBREVIATIONS: AC1 ¼ agreement coefficient 1; CC/IT ¼ intercaudate distance-to-inner-table width; ESCAPE-NA1 ¼ Safety and Efficacy of Nerinetide (NA-1) in Subjects Undergoing Endovascular Thrombectomy for Stroke; GCA ¼ global cortical atrophy; h-ICD ¼ hemi-intercaudate distance; MTA ¼ medial temporal atrophy

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Section: Discussionmentioning

confidence: 86%

Cortical and Subcortical Brain Atrophy Assessment Using Simple Measures on NCCT Compared with MRI in Acute Stroke

Jaroenngarmsamer,

Benali,

Fladt

et al. 2023

AJNR Am J Neuroradiol

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“… 16 In addition, we observed an increased proportion of patients with ischemic stroke in the medical history among LVO patients with renal insufficiency and CE that can be interpreted as a marker for previous cerebral damage and frailty of brain tissue, which indicated the impaired ability of acute stroke patients to cope with the injury, even if treated by tirofiban. 17 …”

Section: Discussionmentioning

confidence: 99%

Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function

Liu,

Li,

Chen

et al. 2023

Ann Clin Transl Neurol

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ObjectiveRenal function can modify the outcomes of large vessel occlusion (LVO) stroke across stroke etiologies in disparate degrees. The presence of renal function deficit can also impair the pharmacokinetics of tirofiban. Hence, this study aimed to investigate the roles of renal function in determining efficacy and safety of intravenous tirofiban before endovascular treatment (EVT) for acute ischemic stroke patients with large vessel occlusion (LVO).MethodsThis study was a post hoc exploratory analysis of the RESCUE‐BT trial. The primary outcome was the proportion of patients achieving functional independence (modified Rankin scale 0–2) at 90 days, and the primary safety outcome was the rate of symptomatic intracranial hemorrhage (sICH).ResultsAmong 908 individuals with available serum creatinine, decreased estimated glomerular filtration rate (eGFR) status was noted more commonly in patients with cardioembolic stroke (CE), while large artery atherosclerosis (LAA) was predominant in patients with normal renal function. In LAA with normal renal function, tirofiban was associated with higher rates of functional independence at 90 days (41.67% vs 59.80%, p = 0.003). However, for LVO patients with renal dysfunction, tirofiban did not improve functional outcomes for any of the etiologies (LAA, p = 0.876; CE, p = 0.662; others, p = 0.894) and significantly increased the risk of sICH among non‐LAA patients (p = 0.020). Mediation analysis showed tirofiban reduced thrombectomy passes (12.27%) and drug/placebo to recanalization time (14.25%) mediated its effects on functional independence.ConclusionThis present study demonstrated the importance of evaluating renal function before administering intravenous tirofiban among patients with LVO who are planned to undergo EVT.

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“…Thus, both proxies-brain volume and its atrophy-might capture different variances in the elderly population. Despite the application of different methods on brain atrophy assessment, several studies demonstrated its negative impact on stroke outcome and recovery trajectories [17][18][19][20][21]. The impact of brain atrophy in malignant stroke has been reported to be more complex, with a trend towards mortality reduction but a worsening of functional recovery [22].…”

Section: Potential Proxies Of Brain Reserve In Stroke Patientsmentioning

confidence: 99%

Adaptation of the Concept of Brain Reserve for the Prediction of Stroke Outcome: Proxies, Neural Mechanisms, and Significance for Research

Umarova,

Gallucci,

Hakim

et al. 2024

Brain Sciences

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The prediction of stroke outcome is challenging due to the high inter-individual variability in stroke patients. We recently suggested the adaptation of the concept of brain reserve (BR) to improve the prediction of stroke outcome. This concept was initially developed alongside the one for the cognitive reserve for neurodegeneration and forms a valuable theoretical framework to capture high inter-individual variability in stroke patients. In the present work, we suggest and discuss (i) BR-proxies—quantitative brain characteristics at the time stroke occurs (e.g., brain volume, hippocampus volume), and (ii) proxies of brain pathology reducing BR (e.g., brain atrophy, severity of white matter hyperintensities), parameters easily available from a routine MRI examination that might improve the prediction of stroke outcome. Though the influence of these parameters on stroke outcome has been partly reported individually, their independent and combined impact is yet to be determined. Conceptually, BR is a continuous measure determining the amount of brain structure available to mitigate and compensate for stroke damage, thus reflecting individual differences in neural resources and a capacity to maintain performance and recover after stroke. We suggest that stroke outcome might be defined as an interaction between BR at the time stroke occurs and lesion load. BR in stroke can potentially be influenced, e.g., by modifying cardiovascular risk factors. In addition to the potential power of the BR concept in a mechanistic understanding of inter-individual variability in stroke outcome and establishing individualized therapeutic approaches, it might help to strengthen the synergy of preventive measures in stroke, neurodegeneration, and healthy aging.

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Association of Brain Atrophy With Functional Outcome and Recovery Trajectories After Thrombectomy

Cited by 5 publications

References 29 publications

Cortical and Subcortical Brain Atrophy Assessment Using Simple Measures on NCCT Compared with MRI in Acute Stroke

Cortical and Subcortical Brain Atrophy Assessment Using Simple Measures on NCCT Compared with MRI in Acute Stroke

Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function

Adaptation of the Concept of Brain Reserve for the Prediction of Stroke Outcome: Proxies, Neural Mechanisms, and Significance for Research

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