Brain Atrophy and the Risk of Futile Endovascular Reperfusion in Acute Ischemic Stroke

Abstract

Background and Purpose— We aimed to evaluate the impact of brain atrophy on long-term clinical outcome in patients with acute ischemic stroke treated with endovascular therapy, and more specifically, to test whether there are interactions between the degree of atrophy and infarct volume, and between atrophy and age, in determining the risk of futile reperfusion. Methods— We studied consecutive patients with acute ischemic stroke with proximal anterior circulation intracranial arterial occlusions treated with endovascular therapy achieving successful arterial recanalization. Brain atrophy was evaluated on baseline computed tomography with the global cortical atrophy scale, and Evans index was calculated to assess subcortical atrophy. Infarct volume was assessed on control computed tomography at 24 hours using the formula for irregular volumes (A×B×C/2). Main outcome variable was futile recanalization, defined by functional dependence (modified Rankin Scale score >2) at 3 months. The predefined interactions of atrophy with age and infarct volume were studied in regression models. Results— From 361 consecutive patients with anterior circulation acute ischemic stroke treated with endovascular therapy, 295 met all inclusion criteria. Futile reperfusion was observed in 144 out of 295 (48.8%) patients. Cortical atrophy affecting parieto-occipital and temporal regions was associated with futile recanalization. Total global cortical atrophy score and Evans index were independently associated with futile recanalization in an adjusted logistic regression. Multivariable adjusted regression models disclosed significant interactions between global cortical atrophy score and infarct volume (odds ratio, 1.003 [95%CI, 1.002–1.004], P <0.001) and between global cortical atrophy score and age (odds ratio, 1.001 [95% CI, 1.001–1.002], P <0.001) in determining the risk of futile reperfusion. Conclusions— A higher degree of cortical and subcortical brain atrophy is associated with futile endovascular reperfusion in anterior circulation acute ischemic stroke. The impact of brain atrophy on insufficient clinical recovery after endovascular reperfusion appears to be independently amplified by age and by infarct volume.

Systemic Inflammatory Response Index and Futile Recanalization in Patients with Ischemic Stroke Undergoing Endovascular Treatment

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Prognostic Value of Abnormal Liver Function Tests After Mechanical Thrombectomy for Acute Ischemic Stroke

“…Conventional factors including age, baseline disability, history of hypertension, and hyperglycemia were known to be associated with worse prognosis in AIS patients treated with MT ( 3 ). Besides, radiological markers of chronic brain damage, such as cortical microinfarcts ( 4 ), leukoaraiosis ( 5 ), brain atrophy ( 6 ), and cerebral microbleeds ( 7 ), have recently been identified as risk factors of poor clinical outcomes. Comorbidities and complications such as malignant brain edema ( 8 ), pneumonia ( 9 ), and renal dysfunction ( 10 ) were reported as potential risk factors for worse prognosis, too.…”

Severe Brain Atrophy Predicts Poor Clinical Outcome After Endovascular Treatment of Acute Basilar Artery Occlusion: An Automated Volumetric Analysis of a Nationwide Registry

“…Brain atrophy, indicating the loss of brain cells or their connections, has recently been presented as a new, reliable imaging marker for predicting poor functional outcomes in patients with anterior circulation stroke treated with intravenous thrombolysis or EVT (Lauksio et al, 2020;Pedraza et al, 2020). However, compared with anterior circulation stroke, which damages cerebral hemispheres, in patients with ABAO, the subtentorial structures are frequently impaired; such patients might benefit from brain atrophy, which provides compensation space and increases tolerance of space-occupying conditions, thereby decreasing the probability of brain herniation, decreasing mortality, and promoting recovery (Mattle et al, 2011;Delcourt et al, 2020).…”