Another useless piece of describing a problem with NO solution provided! I'd fire everyone involved in this crapola!
Brain Frailty and Functional Outcomes After Thrombolysis for Acute Ischemic Stroke
SpencerP.Loewen,PhD;NishitaSingh,MD;IbrahimAlhabli,MD;FouziBala,MD;BrianBuck,MD;FaysalBenali,MD;WilliamBetzner,MSc;KadenLam,BHSc;
LucianaCatanese,MD;AleksanderTkach,MD;DarDowlatshahi,MD,PhD;FedericoCarpani,MD;ThaliaS.Field,MD;GaryHunter,MD;HoumanKhosravani,MD,PhD;
AleksandraPikula,MD;MichelShamy,MD,MA;TolulopeT.Sajobi,PhD;MohammedAlmekhlafi,MD,MSc;RickSwartz,MD;BijoyMenon,MD;
MaheshKate,DM;AravindGanesh,MD,DPhil(Oxon)
Abstract
IMPORTANCE
The cumulative burden of chronic vascular and neurodegenerative changes
contributes to brain frailty, which may reduce the brain’s capacity to recover from acute ischemic
stroke (AIS). The association between brain frailty markers and post stroke outcomes after
thrombolysis is unclear.
OBJECTIVE
To evaluate associations between brain frailty assessed on non–contrast-enhanced
computed tomography(NCCT) and magnetic resonance imaging(MRI) and functional outcome in
patients with AIS treated with intravenous thrombolysis.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study was a posthoc analysis of the Alteplase
compared to Tenecteplase(AcT) trial, an investigator-led, registry-linked, parallel-group, open
label, randomized clinical trial that enrolled patients between December10, 2019,and January25, 2022, at 22 primary and comprehensive stroke centers across Canada. Participants included adults
18 years or older diagnosed with ischemic stroke causing disabling neurological deficit, presenting
within 4.5 hours of symptom onset, and meeting Canadian guidelines for thrombolysis. Markersof
brain frailty(cortical and subcortical atrophy, white matter changes[Fazekas score,grouped as 0,1-2,
and3-6],lacunes, chronic infarctions, and[on MRI] microbleeds, siderosis, and enlarged perivascular
spaces) were retrospectively assessed while reviewers were blinded to outcome variables. Analyses
were performed from July 24, 2024, to March 25,2025.
EXPOSURES
Patients underwent baseline NCCT and were randomized to receive intravenous
thrombolysis with alteplase(0.9mg/kg) or tenecteplase (0.25mg/kg). Some patients also received
post treatment brain MRI.
MAIN OUTCOMES AND MEASURES
The primary outcome was excellent functional outcome
(modified Rankin Scale [mRS]scoreof0-1) at 90days. Secondary outcomes included 90-day ordinal
mRS score(trichotomizedas0-2,3-4, and 5-6), symptomatic intracerebral hemorrhage, and
mortality. Sensitivity analyses were performed in patients with available MRI scans.
RESULTS
Among the 1568 patients (median age,74[IQR,63-83]years;817male[52.1%])with
interpretable NCCT findings, after correcting for multiple comparisons, higher total Fazekas score of
3 to 6 compared with 0 was associated with lower odds of a 90-day mRS score of 0 to 1(adjusted
odds ratio[OR],0.40[95%CI,0.24-0.65]). Total Fazekas score(adjusted common OR[ACOR],2.80
[95%CI,1.88-4.16]),corticalatrophy(ACOR,2.65[95%CI.1.63-4.32]),andtotalbrainfrailtyscore
(ACOR,3.15[95%CI,1.87-5.33])were each associated with worse ordinal mRS, but were not
associated with safety outcomes.
CONCLUSIONS AND RELEVANCE
In this cohort study of patients with AIS treated with
intravenous thrombolysis, brain frailty markers—particularly white matter changes, cortical atrophy,
and total brain frailty—were associated with worse outcomes. Consideration of these neuroimaging
markers may better inform clinicians and patients about treatment expectations from
thrombolytic therapy
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