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

Je Woo Park, Joon Tae Kim, Ji Sung Lee, Beom Joon Kim, Joonsang Yoo, Jung Hoon Han, Bum Joon Kim, Chi Kyung Kim, Jae Guk Kim, Sung Hyun Baik, Jong Moo Park, Kyusik Kang, Soo Joo Lee, Hyungjong Park, Jae Kwan Cha, Tai Hwan Park, Kyungbok Lee, Jun Lee, Keun Sik Hong, Byung Chul LeeDong Eog Kim, Jay Chol Choi, Jee Hyun Kwon, Dong Ick Shin, Sung Il Sohn, Sang Hwa Lee, Wi Sun Ryu, Juneyoung Lee, Hee Joon Bae

Research output: Contribution to journalArticlepeer-review

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) (Faze-kas 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 inde-pendently 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 isch-emic 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.

Original languageEnglish
Pages (from-to)175-185
Number of pages11
JournalJournal of Clinical Neurology (Korea)
Volume20
Issue number2
DOIs
StatePublished - Mar 2024

Keywords

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

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