Enregistrement W4409873073 · doi:10.1212/wnl.0000000000213619

Impact of Brain Frailty on Clinical Presentation and Neurologic Recovery in Acute Ischemic Stroke Patients Undergoing Thrombectomy

2025· article· en· W4409873073 sur OpenAlexaff

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Thorén, Boris Keselman, Niaz Ahmed, Åke Holmberg, Maria Axelsson, Annika Berglund, Amir Golsari, Julia Hoppe, Milani Deb‐Chatterji, Bastian Cheng, Ewgenia Barow, Eckhard Schlemm, Iris Lettow, Märit Jensen, Dagmar Otto, Kirsten Jaramillo, Hannes Appelbohm, Jens Fiehler, Maxim Bester, Michael Schönfeld, Caspar Brekenfeld, Brigette Holst, Ginette Wortmann, Friederike Koch, Johannes Gerber, Andrij Abramyuk, Daniel Kaiser, Simon Winzer, Alexandra Prakapenia, Lars‐Peder Pallesen, Timo Siepmann, Kristian Barlinn, Kathrin Haase, Angela Sauer, Marios‐Nikos Psychogios, Jan Liman, Alex Brehm, Volker Maus, Nicole Hollstein, Annika Reinke, Gustav Neitz, Marlena Schnieder, Margret Schwarz, Allam Ibrahim, Julia Müller, Stefanie Meister, Berit Bäumle, René Chapot, Sara Pilgram‐Pastor, Marta Wallocha, Michael C. Stauder, Ekin Celik, Paul Stracke, Nicole Müller, Ralph Weber, Roland Veltkamp, Simon Nagel, Peter A. Ringleb, Miriam Heyse, Hemasse Amiri, Sibu Mundiyanapurath, Min Chen, Elisabeth Beyrle, Perdita Beck, Markus Möhlenbruch

Notice bibliographique

RevueNeurology · 2025

Typearticle

Langueen

DomaineMedicine

ThématiqueAcute Ischemic Stroke Management

Établissements canadiensUniversity of TorontoUniversity Health NetworkUniversity of CalgaryCentre Hospitalier de l’Université de MontréalLibin Cardiovascular Institute of AlbertaUniversity of ManitobaUniversity of Alberta

Organismes subventionnairesnon disponible

Mots-clésMedicineStroke (engine)Presentation (obstetrics)Ischemic strokeBrain ischemiaIschemiaInternal medicineSurgery

DOI10.1212/wnl.0000000000213619

Résumé

récupéré en direct d'OpenAlex

Background and ObjectivesBrain frailty impairs the ability to compensate for brain dysfunction and is linked to worse outcomes after stroke. Stroke severity at presentation is a key determinant of outcomes in acute ischemic stroke. This study aimed to examine the impact of brain frailty on initial stroke severity and recovery in acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT). MethodsWe conducted a post hoc analysis of the ESCAPE-NA1 randomized-controlled trial that investigated the efficacy and safety of the neuroprotectant nerinetide in patients with AIS who received EVT. Brain frailty markers (cortical atrophy, subcortical atrophy, white matter hyperintensities, chronic infarcts) were visually assessed from baseline noncontrast CT scans. We explored the association between these markers and admission stroke severity (National Institutes of Health Stroke Scale [NIHSS] score) using multivariable quantile regression. We also assessed the NIHSS trajectory over 90 days using repeated-measures analysis. Models were adjusted for relevant covariates. ResultsAmong 1,102 participants (mean age 69.5 years; 49.7% female), NIHSS scores at baseline were higher in patients with cortical atrophy and those with chronic infarcts compared with patients having no cortical atrophy or chronic infarcts after adjusting for confounders (adjusted difference for GCA1 vs GCA0 = 1.25 points [95% CI 0.18–2.31], p = 0.021; adjusted difference for presence of chronic infarcts = 1.27 points [95% CI 0.007–2.53, p = 0.049]). Subcortical atrophy, white matter hyperintensity burden, lacunes, and overall brain frailty were not associated with NIHSS scores at presentation. A repeated-measures analysis showed consistent higher NIHSS scores in individuals with brain frailty compared with those without, after the acute phase throughout the 90-day follow-up period (NIHSS score at 30 days, adjusted difference for total brain frailty score 1 vs 0 = 1.16 points [95% CI 0.35–1.96], p = 0.01; brain frailty score 2/3 vs 0 = 0.98 [95% CI 0.08–1.88], p = 0.03; NIHSS score at 90 days (adjusted difference for brain frailty score 1 vs 0 = 0.97 [95% CI 0.19–1.75], p = 0.01; brain frailty score 2/3 vs 0 = 0.85 [95% CI −0.01 to –1.71], p = 0.05). DiscussionThis study highlights the association of brain frailty with the clinical presentation and recovery trajectory of patients with AIS undergoing EVT. Specifically, cortical atrophy was independently associated with baseline stroke severity, and the total burden of brain frailty was independently associated with NIHSS recovery trajectories. The results emphasize the importance of considering brain frailty in acute stroke management and prognostication.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.

Comment cette classification a été obtenuedéplier

Prédiction machine sur la base complète

Imitation des enseignants

Ni prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.

score de la tête « metaresearch » (Codex)0,001

score de la tête « metaresearch » (Gemma)0,005

Version: metacan-v3-hybrid-931329e0061cStatut de validation: machine_predicted_unvalidated

Catégories candidatesaucune

Catégories consensuellesaucune

DomaineSignal candidat: aucune · Signal consensuel: aucune

Devis d'étudeSignal candidat: Observationnel · Signal consensuel: Observationnel

GenreSignal candidat: Empirique · Signal consensuel: Empirique

Score de désaccord entre enseignants0,002

Score d'incertitude au seuil0,006

Scores du classifieur distillé par catégorie (deux têtes)

Catégorie	Codex	Gemma
Métarecherche	0,001	0,005
Méta-épidémiologie (sens strict)	0,000	0,000
Méta-épidémiologie (sens large)	0,000	0,001
Bibliométrie	0,000	0,000
Études des sciences et des technologies	0,000	0,000
Communication savante	0,000	0,000
Science ouverte	0,000	0,000
Intégrité de la recherche	0,000	0,000
Charge utile insuffisante (le modèle a refusé de juger)	0,001	0,000

Scores machine (provisoires)

Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.

Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.

Tête enseignante Opus0,027

Tête enseignante GPT0,360

Écart entre enseignants0,332 · la distance entre les deux têtes enseignantes sur ce seul travail

Statut de validationscore_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle

Classification

machine, non validée

Prédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.

Les modèles n’ont appliqué aucune catégorie : rien dans la taxonomie ne correspondait à ce travail.

Devis d'étudeObservationnel

Domainenon disponible

GenreEmpirique

Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».

En bref

Citations8

Publié2025

Routes d'admission1

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