Association of masseter area and radiodensity with three-month survival after proximal anterior circulation occlusion

Abstract

BackgroundMasseter area (MA), a surrogate for sarcopenia, appears to be useful when estimating postoperative survival, but there is lack of consensus regarding the potential predictive value of sarcopenia in acute ischemic stroke (AIS) patients. We hypothesized that MA and density (MD) evaluated from pre-interventional CT angiography scans predict postinterventional survival in patients undergoing mechanical thrombectomy (MT).Materials and methods312 patients treated with MT for acute occlusions of the internal carotid artery (ICA) or the M1 segment of the middle cerebral artery (M1-MCA) between 2013 and 2018. Median follow-up was 27.4 months (range 0–70.4). Binary logistic (alive at 3 months, OR <1) and Cox regression analyses were used to study the effect of MA and MD averages (MAavg and MDavg) on survival.ResultsIn Kaplan–Meier analysis, there was a significant inverse relationship with both MDavg and MAavg and mortality (MDavg P<0.001, MAavg P=0.002). Long-term mortality was 19.6% (n=61) and 3-month mortality 12.2% (n=38). In multivariable logistic regression analysis at 3 months, per 1-SD increase MDavg (OR 0.61, 95% CI 0.41 to 0.92, P=0.018:) and MAavg (OR 0.57, 95% CI 0.35 to 0.91, P=0.019) were the independent predictors associated with lower mortality. In Cox regression analysis, MDavg and MAavg were not associated with long-term survival.ConclusionsIn acute ischemic stroke patients, MDavg and MAavg are independent predictors of 3-month survival after MT of the ICA or M1-MCA. A 1-SD increase in MDavg and MAavg was associated with a 39%–43% decrease in the probability of death during the first 3 months after MT.

Brain atrophy predicts mortality after mechanical thrombectomy of proximal anterior circulation occlusion

“…[11] Similarly, in our previous work, we demonstrated that MDavg and MAavg are independent predictors of three-month survival after MT of the ICA or M1. [18] Masseter muscle parameters remained as significant predictors of mortality when included as covariates in the model along with BAI also in the present study. This finding suggests that both BAI and masseter sarcopenia are predictors of three-month mortality in MT patients.…”

“…In our previous studies, we have demonstrated the excellent feasibility and reliability of MAavg and MDavg measurements from routine CTA images in clinical work and their relation with survival in carotid endarterectomy and MT patients. [18,23] In the present study, we found that brain atrophy is associated with an increased risk of three-month mortality after MT. Although magnetic resonance imaging is frequently used for detection of degenerative brain changes, it is often not available in acute situations unlike CT. BAI measured from routine CT images with excellent reproducibility, similar to masseter parameters, could therefore provide an additional prognostic tool in identifying which patients with a large-vessel occlusion will benefit from MT.…”

“…[15] Moreover, brain atrophy is associated with physical frailty, [16,17] and in our previous study we showed that sarcopenia, represented by masseter muscle area and 3 density, is associated with poor three-month survival after MT. [18] The potential predictive value of BAI and its dependence on sarcopenia as well as other risk factors in AIS patients treated with MT remains poorly defined. We hypothesized that including BAI in multivariable models could improve the prediction of mortality after MT due to AIS.…”

“…The excellent inter-and intra-observer reliability of masseter area and density measurements have been demonstrated by independent observers in previous studies. [18,23] The same reproducibility analyses were performed for BAI and Fazekas in order to confirm inter-observer reliability. Consequently, 30 CT scans of the MT patients were randomly selected and evaluated by two independent radiologists.…”

Comprehensive Analysis Using CT Anthropometry Verifies the Association of Psoas and Masseter Muscle With Traumatic Brain Injury

“…[14] Also it shows association with prognosis of patient with cerebrovascular problem. [15,16] And Hu et al reported that MMA is associated with early mortality of patients with severe traumatic brain injury (TBI). [17] Both PMA and MMA have enough evidence to prove themselves as valid markers for prognosis of various patients.…”