Brain Frailty and Functional Outcomes After Thrombolysis for Acute Ischemic Stroke

Area of Science:

• Neurology
• Radiology
• Vascular Medicine

Background:

• Chronic vascular and neurodegenerative changes contribute to brain frailty, potentially impairing recovery from acute ischemic stroke (AIS).
• The relationship between brain frailty indicators and outcomes following thrombolysis for AIS remains unclear.

Purpose of the Study:

• To assess the association between brain frailty markers, identified via non-contrast-enhanced computed tomography (NCCT) and magnetic resonance imaging (MRI), and functional outcomes in AIS patients receiving intravenous thrombolysis.

Main Methods:

• A post hoc analysis of the Alteplase compared to Tenecteplase (AcT) trial involving 1568 adult patients with AIS treated with thrombolysis.
• Retrospective assessment of brain frailty markers (atrophy, white matter changes [Fazekas score], lacunes, chronic infarctions, microbleeds, siderosis, enlarged perivascular spaces) by blinded reviewers.
• Primary outcome: excellent functional outcome (modified Rankin Scale [mRS] score 0-1) at 90 days; secondary outcomes included ordinal mRS, hemorrhage, and mortality.

Main Results:

• Higher Fazekas scores (3-6 vs 0) were associated with lower odds of excellent 90-day functional outcome (adjusted OR, 0.40).
• Increased Fazekas score, cortical atrophy, and total brain frailty score were each linked to worse 90-day ordinal mRS scores.
• No association was found between these brain frailty markers and safety outcomes like symptomatic intracerebral hemorrhage or mortality.

Conclusions:

• Brain frailty markers, especially white matter changes and cortical atrophy, are associated with worse functional outcomes in patients with AIS treated with thrombolysis.
• Neuroimaging assessment of brain frailty may improve predictions of treatment response and patient expectations for thrombolytic therapy.