CT-Based Brain Frailty Signs and Clinical Outcomes Following Endovascular Stroke Thrombectomy

The impact of brain frailty signs on baseline imaging on clinical outcomes in stroke patients remains unclear. Therefore, we evaluated admission CT markers of brain frailty and their correlation to outcomes in patients with large vessel occlusions (LVO) that underwent endovascular thrombectomy (EVT).

Data from a single-center prospective stroke registry of patients who underwent EVT were retrospectively analyzed. Demographics, medical history, clinical data, admission laboratory values, and 90-day functional outcomes were reviewed. Admission non-contrast CT (NCCT) scans were evaluated for Evans Index (EI) and brain-frailty signs, including the presence and degree of atrophy, white-matter changes, and old vascular lesions. Patients with pre-stroke brain frailty were compared with those without frailty signs, and regression analyses were used to assess the effects on outcomes.

Overall, 319 participants were included; 263 (82.4%) had brain atrophy, 158 (49.5%) had white-matter changes, and 131 (41.1%) had prior vascular lesions. After adjustment for age, stroke severity and other confounders, brain-frailty signs or the EI failed to show significant associations with functional outcomes. White-matter changes were associated with higher rates of symptomatic intracerebral hemorrhage and in-hospital complications, and greater atrophy severity was linked to increased rates of in-hospital complications and 90-day mortality. No association was found between brain frailty and length of hospital stay.

Admission NCCT markers for pre-stroke brain frailty were not independently associated with 90-day functional outcomes following EVT. These findings suggest that admission NCCT-detected brain frailty should not be used to exclude patients with LVO from undergoing EVT.