J Clin Neurol.  2024 Mar;20(2):175-185. 10.3988/jcn.2023.0181.

Brain Frailty and Outcomes of Acute Minor Ischemic Stroke With Large-Vessel Occlusion

• Park JW
• Kim JT
• Lee JS
• Kim BJ
• Yoo J
• Han JH
• Kim BJ
• Kim CK
• Kim JG
• Baik SH
• Park JM
• Kang K
• Lee SJ
• Park H
• Cha JK
• Park TH
• Lee K
• Lee J
• Hong KS
• Lee BC
• Kim DE
• Choi JC
• Kwon JH
• Shin DI
• Sohn SI
• Lee SH
• Ryu WS
• Lee J
• Bae HJ

• KMID: 2553499
• DOI: http://doi.org/10.3988/jcn.2023.0181

Abstract

Background and Purpose
The influence of imaging features of brain frailty on outcomes were investigated in acute ischemic stroke patients with minor symptoms and large-vessel occlusion (LVO).
Methods
This was a retrospective analysis of a prospective, multicenter, nationwide registry of consecutive patients with acute (within 24 h) minor (National Institutes of Health Stroke Scale score=0–5) ischemic stroke with anterior circulation LVO (acute minor LVO). Brain frailty was stratified according to the presence of an advanced white-matter hyperintensity (WMH) (Fazekas grade 2 or 3), silent/old brain infarct, or cerebral microbleeds. The primary outcome was a composite of stroke, myocardial infarction, and all-cause mortality within 1 year.
Results
In total, 1,067 patients (age=67.2±13.1 years [mean±SD], 61.3% males) were analyzed. The proportions of patients according to the numbers of brain frailty burdens were as follows: no burden in 49.2%, one burden in 30.0%, two burdens in 17.3%, and three burdens in 3.5%. In the Cox proportional-hazards analysis, the presence of more brain frailty burdens was associated with a higher risk of 1-year primary outcomes, but after adjusting for clinically relevant variables there were no significant associations between burdens of brain frailty and 1-year vascular outcomes. For individual components of brain frailty, an advanced WMH was independently associated with an increased risk of 1-year primary outcomes (adjusted hazard ratio [aHR]=1.33, 95% confidence interval [CI]=1.03–1.71) and stroke (aHR=1.32, 95% CI=1.00–1.75).
Conclusions
The baseline imaging markers of brain frailty were common in acute minor ischemic stroke patients with LVO. An advanced WMH was the only frailty marker associated with an increased risk of vascular events. Further research is needed into the association between brain frailty and prognosis in patients with acute minor LVO.

Keyword

brain frailty; white-matter hyperintensity; acute ischemic stroke; large-vessel occlusion; acute minor stroke