Impact of brain frailty on complications and outcomes in acute ischemic stroke

BACKGROUNDThis study aimed to determine the association of brain frailty with acute complications and prognosis in patients with acute ischemic stroke (AIS) due to occlusion of large vessels in the anterior circulation, and to further assess its predictive value. METHODS AND RESULTSThis multicenter, retrospective study included patients with AIS due to large vessel occlusion in the anterior circulation. All patients underwent MRI within seven days of stroke onset, measuring subcortical and cortical atrophy and leukoaraiosis as indicators of brain frailty.The study included 1,090 patients with a median age of 64 (interquartile range, 55-73) years and a median National Institutes of Health Stroke Scale (NIHSS) score of 9 (interquartile range, 4.5-15). Multivariable logistic regression analysis showed that independent risk factors for the unfavorable clinical outcome included: NIHSS score (OR, 1.17; 95% CI, 1.13-1.22), blood glucose (OR, 1.15; 95% CI, 1.04-1.26), infarct volume (OR, 1.32; 95% CI, 1.15-1.52), subcortical atrophy (OR, 1.27; 95% CI, 1.18-1.37), severe cortical atrophy (OR, 5.46; 95% CI, 1.71-17.45), and severe leukoaraiosis (OR, 4.68; 95% CI, 1.93-11.31). However, brain frailty was not significantly associated with AIS complications (malignant cerebral edema, parenchymal hemorrhage). Including brain atrophy indicators in the model significantly improved its unfavorable clinical outcome predictive power (AUC increased from 0.762 to 0.822; p < 0.001). The results remained stable in subgroup analyses across treatment modalities. CONCLUSIONSBrain frailty was significantly associated with the unfavorable clinical outcome but not with acute complications. Brain frailty indicators contributed to the predictive efficacy, regardless of treatment modality.