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Ischemic Stroke
Original research
Association of masseter area and radiodensity with three-month survival after proximal anterior circulation occlusion
  1. Iisa Lindström1,
  2. Sara Protto2,
  3. Niina Khan2,
  4. Jussi Hernesniemi1,3,4,
  5. Niko Sillanpää2,
  6. Niku Oksala1,2,4
  1. 1 Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
  2. 2 Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
  3. 3 Department of Cardiology, Tampere University Hospital, Heart Hospital, Tampere, Finland
  4. 4 Finnish Cardiovascular Research Center, Tampere University Hospital, Tampere, Finland
  1. Correspondence to Iisa Lindström, Surgery, Faculty of Medicine and Health Technology, Tampere University, Tampere 33014, Finland; iisa.lindstrom{at}tuni.fi

Abstract

Background Masseter area (MA), a surrogate for sarcopenia, appears to be useful when estimating postoperative survival, but there is lack of consensus regarding the potential predictive value of sarcopenia in acute ischemic stroke (AIS) patients. We hypothesized that MA and density (MD) evaluated from pre-interventional CT angiography scans predict postinterventional survival in patients undergoing mechanical thrombectomy (MT).

Materials and methods 312 patients treated with MT for acute occlusions of the internal carotid artery (ICA) or the M1 segment of the middle cerebral artery (M1-MCA) between 2013 and 2018. Median follow-up was 27.4 months (range 0–70.4). Binary logistic (alive at 3 months, OR <1) and Cox regression analyses were used to study the effect of MA and MD averages (MAavg and MDavg) on survival.

Results In Kaplan–Meier analysis, there was a significant inverse relationship with both MDavg and MAavg and mortality (MDavg P<0.001, MAavg P=0.002). Long-term mortality was 19.6% (n=61) and 3-month mortality 12.2% (n=38). In multivariable logistic regression analysis at 3 months, per 1-SD increase MDavg (OR 0.61, 95% CI 0.41 to 0.92, P=0.018:) and MAavg (OR 0.57, 95% CI 0.35 to 0.91, P=0.019) were the independent predictors associated with lower mortality. In Cox regression analysis, MDavg and MAavg were not associated with long-term survival.

Conclusions In acute ischemic stroke patients, MDavg and MAavg are independent predictors of 3-month survival after MT of the ICA or M1-MCA. A 1-SD increase in MDavg and MAavg was associated with a 39%–43% decrease in the probability of death during the first 3 months after MT.

  • stroke
  • thrombectomy
  • CT angiography
  • CT

https://doi.org/10.1136/neurintsurg-2020-015837

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    Footnotes

    • Contributors IL participated in research conception and design, data collection, wrote the statistical analysis plan, analyzed data, and wrote and revised the manuscript. SP participated in research conception and design, data collection and revised the manuscript. NK participated in research conception, design and revised the manuscript. JH participated in research conception and design, data collection, statistical analysis and interpretation and revised the manuscript. NS participated in research conception and design, data collection, statistical analysis and interpretation and revised the manuscript. NO participated in research conception and design, data collection, analysis and interpretation, and wrote and revised the manuscript and he is guarantor. All authors agree to be accountable for all aspects of the work.

    • Funding This study was supported by grant from the Academy of Finland (N.O. grants #326420 and #310617).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.