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Original research
Brain atrophy predicts mortality after mechanical thrombectomy of proximal anterior circulation occlusion
  1. Iisa Lauksio1,
  2. Iisa Lindström1,
  3. Niina Khan2,
  4. Niko Sillanpää2,
  5. Jussi Hernesniemi3,4,5,
  6. Niku Oksala1,2,5,
  7. Sara Protto2
  1. 1Surgery, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
  2. 2Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
  3. 3Internal Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
  4. 4Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
  5. 5Finnish Cardiovascular Research Center, Tampere University Hospital, Tampere, Finland
  1. Correspondence to Iisa Lauksio, Surgery, Faculty of Medicine and Health Technology, Tampere University, Tampere 33014, Finland; iisa.lauksio{at}tuni.fi

Abstract

Background Brain atrophy is associated with an inferior functional outcome in patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke. We hypothesized that brain atrophy determined from pre-interventional non-contrast-enhanced CT scans would also be linked to increased mortality in this cohort.

Methods A total of 204 patients treated with MT for acute occlusions of the internal carotid artery (ICA) or the M1 segment of the middle cerebral artery (M1) at Tampere University Hospital, Finland between 2013 and 2017 were retrospectively studied. Brain atrophy index (BAI), masseter muscle surface area and density, chronic ischemic lesions, and white matter lesions were evaluated from pre-interventional CT studies. Logistic regression was applied in analyzing the association of BAI with 3-month mortality.

Results Median age at baseline was 69.9 years (IQR 15.6) and mortality at 3 months was 13.2% (n=27). BAI, measured with excellent reproducibility (intraclass correlation coefficient ≥0.894, p<0.001), was significantly associated with age (r=0.54), white matter lesions (r=0.43), dental status (r=−0.31), masseter area (r=−0.24), masseter density (r=−0.28), and chronic ischemic lesions (r=0.24) (p≤0.001 for all). In univariable analysis, BAI demonstrated a strong association with mortality (OR 2.02, 95% CI 1.34 to 3.05, per 1 SD increase), and none of the other factors associated with mortality remained as significant when included in the same multivariable model. The results remained similar when extending the follow-up up to 2.5 years.

Conclusions Brain atrophy predicts 3-month mortality after MT of the ICA or the M1 independent of age, masseter sarcopenia, chronic ischemic lesions, or white matter lesions.

  • stroke
  • thrombectomy
  • CT
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Footnotes

  • NO and SP contributed equally.

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

  • Funding This study was supported by grants from the Academy of Finland (#326 420 and #310 617 to NO).

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

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