Record 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 on OpenAlexaff

Joachim Fladt, Faysal Benali, Tanaporn Jaroenngarmsamer, Fouzi Bala, Nishita Singh, Raul G. Nogueira, Ryan McTaggart, Andrew M. Demchuk, Alexandre Y. Poppe, Brian Buck, Michael Tymianski, Michael D. Hill, Mayank Goyal, Aravind Ganesh, Eric E. Smith, Simerpreet Bal, Suresh Subramanian, Steven Peters, Philippe Couillard, Gary Klein, Peter K. Stys, Shelagh B. Coutts, John Wong, Alim P. Mitha, Muneer Eesa, William Morrish, Saad Alqatani, Prasanna Venkatesan, Ericka Teleg, Amith Sitaram, Brett Graham, Stephen van Gaal, Aimen Moussaddy, Debabrata Chakraborty, Nicholar Maraj, Andrew Lockey, Shuo Chen, Ravinder Singh, Abdulaziz Sulaiman Alsultan, Ria Asunsian, Dominic Tse, Darshan Doshi, Ondřej Volný, Piyush Ojha, Ankur Wadhwa, Martha Marko, Sanchea Wasyliw, Karla J. Ryckborst, Carol Kenney, Supriya Save, Anitha Jambula, Nancy Newcommon, G Hull, Darcy Blackstock, Sharon Kiszczak, L Zimmel, Michelle Wright, Cari Jahraus, Shelly Bohn, Joseph Paul, Kenneth Butcher, Ashfaq Shuaib, Tom Jeerakathil, Glen C. Jickling, Derek J. Emery, Jeremy Rempel, Richard J. Ower, Robert Ashforth, Tom Yeo, Trevor Kotylak, Cian O′Kelly, Michael Chow, Mizaffar Siddiqui, Maher Saqqur, Atlantic D’Souza, Mar Lloret, Asif Butt, Ali Zohair Nomani, Hayrapet Kalashyan, Sibi Thirunavukkarasu, Juline Jabs, Paige Fairall, Lori Piquette, Stephen Phillips, A. Laine Green, Gordon Gubitz, Jens O. Heidenreich, Thien Huynh, Jai Shankar, William J. Maloney, Robert Vandorpe, Matthias H. Schmidt, Gwynedd E. Pickett, Adrienne Weeks, Juditch Jarrett, Debbie MacDonald, Joanna Arsenault, Ruth Kinnear, Jennifer Mandzia, Michael Mayich, Melfort Boulton, María Bres Bullrich, Sebastián Fridman, Ruba Kiwan, Donald Lee, Stephen Lownie, Alexander V. Khaw, Sachin Pandey, Manas Sharma, Luciano A. Sposato, Kevin Wade, Beth Beauchamp, Lindsay Lambourn, Belinda Amato-Marziali, Daniel Roy, Nicole Deneault, Yan Deschaintre, Laura Gioia, Grégory Jacquin, Céline Odier, Christian Stapf, Daniela Iancu, Jean Raymond, Alain Weill, Marlène Lapierre, Nadia Jadil, Judlène Jolteus, Jeanne Teitelbaum, Mark Angle, Mathew Hannouche, Mohamed Badawy, Justin Létourneau, Maria Cortes, Grant Linnell, Donatella Tampieri, Lucy Vieira, C. LEGAULT, Liam Durcan, Angela Moore, Erin L. Cole, Claire Magnussen, Kristiana Salmon, Salma Khalil, Isabelle Desloges, Lindsay Waxman, Wynne Abdon, Sonia Lai, Dar Dowlatshahi, Michel Shamy, Grant Stotts, Dylan Blacquière, Howard Lesiuk, Aiman Quateen, Brian Drake, Brian Dewar, Zeinab Daham, Michael E. Kelly, Gary Hunter, Lissa Peeling, Ruth Whelan, Aaron Garner, Lilian Urroz, Sharleen Maley, Frank L. Silver, Leanne K. Casaubon, Aleksanda Pikula, Martín del Campo, Joanna D. Schaafsma, Cheryl Jaigobin, Timo Krings, Vítor Mendes Pereira, Ronit Agid, Richard Farb, Libby Kalman, Anne Cayley, Janice E. Williams, Tim Stewart, Karen Misquitta, Aditya Bharatha, Daniel Selchen, Thomas R. Marotta, Dipanka Sarma, Walter Montanera, Julian Spears, Gustavo Saposnik, Pawel Kostyrko, Yangmei Li, Carmen Parra-Fariñas, Jose Danilo Bengzon Diestro, Marie‐Christine Camden, Steve Verreault, Ariane Mackey, Marie‐Ève Audet, Geneviève Milot, Pascale Lavoie, Jean‐Luc Gariépy, Karine Collard, Annette Haché, Demetrios J. Sahlas, Ahmed M. Alshanbari, Josephine Baldwin, Luciana Catanese, Bing Chen, Danielle de Sá Boasquevisque, Aviraj S. Deshmukh, Josrdan M. Knapman, Shana Lamers, Ramiro Larrazabal, Susan V. MacMillan, Alicia M. Mattai, Sumiti Nayar, Kuan H. Ng, Wieslaw Oczkowski, Kanjana Perera, Mays Shawawrah, Ashkan Shoamanesh, Gita Sobhi, Nabeel Muzaffar Syed, Noran Y. Yaher, Cheyanne Vandervelde, Di Wang, Thalia S. 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Monteith, Sidney Starkman, Kunakorn Atchaneeyasakul, Adrian M Burgos, Janice Anne Y. Chua, Nathan Gaines, Ileana Grunberg, Judy Guzy, Zuolu Liu, Neil D. Maluste, Lucas Ramírez, Latisha Sharma, Donald Heck, M Brown, Colin T. McDonald, Mateo Calderon, Mitch Hargis, Christina Roels, Prabhu D. Emmady, Talat Alvi, Mahesh Jayaraman, Shawna M Cutting, Wendy Smith, Susan M. Foley, G Paolucci, Richard Haas, Katie Quinn, Lindsey R. Fuller, Rebecca E. Brierley, Christina C. Watkins, Nicole C. Demir, George Α. Lopez, Alejandro Vargas, Nicholas Osteraas, Becky Holtz, Eric Sauvageau, Amin Aghaebrahim, Mohamad Chmayssani, Neeraj S. Naval, Jason S. Day, Scott Dellorso, Benjamin J. Ludwig, Derek J. Schemmel, Nancy Ebreo, Karen Bell, Lanai Lewis, Marjorie Delucia, Diogo C Haussen, Michael Frankel, Nirav Bhatt, Nicolas Bianchi, Aaron Anderson, Samir Belagaje, Bernardo Liberato, Srikant Rangaraju, Alhamza R Al‐Bayati, Jonathan Grossber, Leah Craft, Kiva Schindler, Erin Schaad, Meagan Schultz, Lorretta J. Sutherly, Shannon Doppelheuer, Jacquelyn Charlton, Jason Faggard, Zuzana Barbret, Ethan DukSoo Han, Robin Walters, Jaydevsinh Dolia, Sleiman El-Jamal, Brendan Eby, Yasir Saleem, Harrison Pearl, Kishan Patel, Haseeb Rahman, Reema Butt, Stephen English, Ajit S Puri, M Howk, Jasmeet Singh, Francesco Massari, Katyucia DeMacedo Rodrigues, Anna Luisa Kühn, Joey English, Nobl Barazangi, Nick Telischak, Warren Kim, Josh Ross, Nata DeVole, Jessica Redford, Melina Lorraine Ferreira, Katie Ponting, Helen Shen, Ann Bedenk, Susila Patel, Julia Fernandess, Michael Ke, Illanit Spokoyny, Billy Gao, David Tong, Xiaomeng Chen, Christine Wong, Jessica Choe, Coleman Martin, Debbie Summers, Christine Boutwell, Karin Olds, Suzanne C. Crandall, John D. Eatman, Naveed Akhtar, W Holloway, Jared S. Halpin, Brett Donegan, Joseph Schindler, Daiv Y. Hwang, Emily J. Gilmore, Nils Petersen, Kevin N. Sheth, Stacy Y. Brown, Rachel Beekman, Benjamin P. George, Firas Kaddouh, Guido J. Falcone, Charles Wira, Charles Matouk, Caitlin Loomis, Hardik Amin, Reshma Narula, Adam Jasne, Lauren Sansing, Tijil Agarwal, Sara Jasak, Dominique Fontaine, Zachary A. King, Lindsey R. Kouhn, Hailey Orgass, Megan A. Leary, Joan Nye, Kelsey Halbert, Karin Nyström, Kaile Neuschatz, Dawn M. Petrucci, Anna Coppola, Treasure A. Joyce, Sam Y. Hou, Mark S. Umekubo, Catrice M. Nakamura, Renee Ovando, Diana Zúñiga, Yih Lin Nien, Fernando Mayor Basto, Allison E. Arch, Laura T. Jong, William A. Conrad, Tara C. Abbott, Jay Z. Yao, Scott D. Caganap, John E. Jordan, George P. Teitelbaum, Robert Darflinger, Daniel F. Kelly, Rishi Gupta, Ronald F. Budzik, Jennifer H. Czerniak, Katherine M. Groezinger, William J. Hicks, Omran Kaskar, Brian Katz, Aaron Loochtan, Peter Pema, Vivek Rai, Nirav Vora, Amanda Brown, Diane Goodman, Barb Danenbergs, Monica Gossett, Oh Young Bang, Jong‐Won Chung, Pyoung Jeon, Keon Ha Kim, Yun Jeong Lim, Ji Hoe Heo, Hyo Suk Nam, Young Dae Kim, Hyungjong Park, In Gun Hwang, Woo‐Seok Ha, Jin Kyo Choi, Kyungsun Jeong, Joung‐Ho Rha, Hee-Kwon Park, Cindy W. Yoon, Bokyung Kim, Sung‐Il Sohn, Chang-Hyun Kim, Joonsang Yoo, Jeong‐Ho Hong, Sohyeon Kim, Moonkyung Choi, Hyoeun Bae, Jun Seok Lee, Jae‐Joon Lee, Go-Eun Jun, Sujeong Jeon, Bruce Campbell, Peter Mitchell, Nawaf Yassi, Stephen M. Davis, Geoffrey A. Donnan, Mark Parsons, Bernard Yan, Richard Dowling, Steven Bush, Teddy Y. Wu, Darshan G. Shan, Henry Zhao, Patrick Salvaris, Fana Alemseged, Felix Ng, Cameron Williams, Anna Balabanski, Ângela dos Santos, Jo-Lyn Ng, Amy McDonald, David M. Jackson, Jessica Tsoleridis, Lauren Pesavento, Timothy Kleinig, Roy Drew, Rebecca Scroop, Lavenia Cagi, Jackson Harvey, Michael J. Waters, John Thornton, Robert P. Brennan, Alan O’Hare, Sarah Power, David Williams, Karl Boyle, Barry J. Moynihan, Ann-Marie Liddy, Margaret Large, Ailbhe Cullen, Roisin Walsh, Emma Martin, Julie Lynch, Sinéad McElroy, Sean Murphy, Sarah Coveney, Caroline Deegan, Gillian Horgan, Peter J. Kelly, Aoife Laffan, Yudy Llamas-Osorio, Catherine T. Lynch, Peter J. Mac Mahon, Michael Marnane, John McCabe, Paul Burns, Suzanne Tauro, Sarah Cuddy, Ian Rennie, Graham Smyth, Peter Flynn, Ivan Wiggam, Enda Kerr, Patricia Gordon, Patricia Fearon, Geralt Roberts, Cathy Patterson, Karen E. Adams, Brian Wells, Margaret McFarland, Tiago Moreira, Christina Sjöstrand, Michael V. Mazya, Håkan Almqvist, Nils Wahlgren, Anna Steinberg, Charith Cooray, Einar E. Eriksson, M. 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

Bibliographic record

VenueNeurology · 2025

Typearticle

Languageen

FieldMedicine

TopicAcute Ischemic Stroke Management

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

Fundersnot available

KeywordsMedicineStroke (engine)Presentation (obstetrics)Ischemic strokeBrain ischemiaIschemiaInternal medicineSurgery

DOI10.1212/wnl.0000000000213619

Abstract

fetched live from 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.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame machine prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.

metaresearch head score (Codex)0.001

metaresearch head score (Gemma)0.005

Version: metacan-v3-hybrid-931329e0061cValidation status: machine_predicted_unvalidated

Candidate categoriesnone

Consensus categoriesnone

DomainCandidate signal: none · Consensus signal: none

Study designCandidate signal: Observational · Consensus signal: Observational

GenreCandidate signal: Empirical · Consensus signal: Empirical

Teacher disagreement score0.002

Threshold uncertainty score0.006

Distilled classifier scores by category (both heads)

Category	Codex	Gemma
Metaresearch	0.001	0.005
Meta-epidemiology (narrow)	0.000	0.000
Meta-epidemiology (broad)	0.000	0.001
Bibliometrics	0.000	0.000
Science and technology studies	0.000	0.000
Scholarly communication	0.000	0.000
Open science	0.000	0.000
Research integrity	0.000	0.000
Insufficient payload (model declined to judge)	0.001	0.000

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.027

GPT teacher head0.360

Teacher spread0.332 · how far apart the two teachers sit on this one work

Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.

The models applied no category: nothing in the taxonomy fit this work.

Study designObservational

Domainnot available

GenreEmpirical

How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".

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Citations8

Published2025

Admission routes1

Has abstractyes

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