Imaging-Based Brain Frailty Predicts Unfavorable Outcomes in Acute Ischemic Stroke

Area of Science:

• Neurology
• Radiology
• Stroke Medicine

Background:

• Brain frailty is defined by imaging markers of chronic cerebrovascular injury.
• The predictive role of brain frailty in acute ischemic stroke complications and prognosis is not well-established.

Purpose of the Study:

• To investigate the association between brain frailty and acute ischemic stroke complications.
• To evaluate the predictive value of brain frailty for unfavorable clinical outcomes in patients with acute ischemic stroke.

Main Methods:

• A multicenter, retrospective study of 1090 patients with anterior circulation large-vessel occlusion ischemic stroke.
• Magnetic resonance imaging was used to assess brain frailty indicators: subcortical and cortical atrophy, and white matter hyperintensity.
• Multivariable logistic regression and receiver operating characteristic curve analyses were performed.

Main Results:

• Brain frailty indicators (subcortical atrophy, severe cortical atrophy, severe white matter hyperintensity) were independently associated with unfavorable clinical outcomes.
• Brain frailty was not significantly associated with acute ischemic stroke complications like malignant cerebral edema or parenchymal hemorrhage.
• Incorporating brain frailty indicators improved the prediction of unfavorable outcomes (AUC increased from 0.762 to 0.822, P<0.001).

Conclusions:

• Brain frailty is a significant predictor of unfavorable clinical outcomes in acute ischemic stroke.
• Brain frailty indicators enhance the predictive accuracy for clinical outcomes, irrespective of treatment modality.