Related Experiment Video
Updated: Aug 13, 2026
Modeling Stroke in Mice: Focal Cortical Lesions by Photothrombosis
Published on: May 6, 2021
The impact of brain atrophy on the outcomes of mechanical thrombectomy
Andre Monteiro1,2, Muhammad Waqas1,2, Hamid H Rai1,2
1Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Objective:
Pre-existing brain atrophy may affect the outcomes of patients treated with mechanical thrombectomy (MT) for large-vessel-occlusion because it is an indicator of low brain reserve. We performed a systematic literature review to assess the impact of brain atrophy on MT-related clinical outcomes.
Methods:
We conducted a systematic search of PubMed, MEDLINE, EMBASE, and Cochrane Library databases from inception to March 2021 using keywords with Boolean operators("brain atrophy"; "atrophy"; "white matter"; and "thrombectomy"). Articles published in English that evaluated the impact of pre-existing brain atrophy on outcomes of MT-treated acute ischemic stroke were eligible for inclusion.
Results:
Four articles were included. Brain atrophy index was a predictor of mortality (odds ratio [OR]:1.81-1.87, 95% confidence interval [CI]:1.16-2.93) after adjustments for age and white matter lesions. Global cortical atrophy scale was an independent predictor of futile recanalization (OR 1.15, 95% CI 1.08-1.22) in multivariate-adjusted logistic regression. Automated measurement of CSF identified increasing volumes associated with reduced 3-month functional independence and higher modified Rankin scale scores. STandards for ReportIng Vascular changes on Neuroimaging criteria for brain atrophy were associated with unfavorable outcome in ordinal-shift analysis (OR 2.72, 95% CI 1.25-5.91).
Conclusions:
The few studies available highlight heterogeneity of neuroimaging methodologies for assessing brain atrophy and difficulty addressing the multiple confounders involved in clinical outcomes. More consistent, accurate investigation is needed before proposing brain atrophy as a possible parameter to improve patient selection for MT.
Advances In Knowledge:
Brain atrophy is associated with many of the clinical confounders frequently present in patients with acute ischemic stroke. Heterogeneity in classification methodologies for brain atrophy and complexity analyzing multiple clinical confounders make it difficult to assess the true impact of this radiological finding on MT-related outcomes.
Insights
Pre-existing brain atrophy may impact outcomes for patients undergoing mechanical thrombectomy (MT). Studies show brain atrophy is linked to higher mortality and poorer functional outcomes after stroke treatment.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Pre-existing brain atrophy, an indicator of reduced brain reserve, may influence patient outcomes following mechanical thrombectomy (MT).
- Assessing the impact of brain atrophy on MT outcomes is crucial for patient selection and treatment planning in acute ischemic stroke.
Purpose of the Study:
- To systematically review and assess the impact of pre-existing brain atrophy on clinical outcomes in patients treated with mechanical thrombectomy for large-vessel occlusion.
Main Methods:
- A systematic literature search was conducted across PubMed, MEDLINE, EMBASE, and Cochrane Library databases up to March 2021.
- Keywords included "brain atrophy," "atrophy," "white matter," and "thrombectomy."
- Four studies evaluating the impact of brain atrophy on MT-treated acute ischemic stroke outcomes were included.
Main Results:
- Brain atrophy index predicted mortality (OR: 1.81-1.87) and global cortical atrophy scale predicted futile recanalization (OR 1.15).
- Automated CSF volume measurements correlated with reduced functional independence and higher modified Rankin Scale scores.
- STandards for ReportIng Vascular changes on Neuroimaging (STRIVE) criteria for brain atrophy were associated with unfavorable outcomes (OR 2.72).
Conclusions:
- Current studies indicate brain atrophy is associated with clinical confounders in acute ischemic stroke patients.
- Heterogeneity in neuroimaging methodologies for assessing brain atrophy complicates outcome analysis.
- Further consistent and accurate research is needed to establish brain atrophy as a parameter for improving patient selection for MT.
