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

作者：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, for the ESCAPE-NA1 Investigators, Philip A. Barber, 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, 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, Nishita Singh, 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, Linda Andersen, Shelly Bohn, Joseph Paul, Brian Buck, 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, Aimen Moussaddy, 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, Daniela Iancu, Michel Shamy, Grant Stotts, Dylan Blacquière, Howard Lesiuk, Aiman Quateen, Brian Drake, Brian Dewar, Zeinab Daham, Michael E. Kelly, Gary Hunter, Lissa Peeling, Brett Graham, 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, Lauren M. Mai, 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. Field, Stephen van Gaal, Philip Teal, Oscar Benavente, Laura Wilson, Sharanpal Mann, Samuel Yip, Colleen B. Murphy, Manraj K. S. Heran, Axel Rohr, Fabio Settecase, Gary Redekop, Charles S. Haw, Genoveva Maclean, Karina Murray, Rosalin Chiu, Alana M. Flexman, Eilidh Strecha, Yolanda Gayton, Judy Yip, Richard H. Swartz, Mark I. Boulos, David J. Gladstone, Amy Yu, Julia Hopyan, Houman Khosravani, Herbert A. Manosalva Alzate, Alisia Southwell, Maneesha Kamra, Kaitlyn Lopes, Arunima Kapoor, Leodante da Costa, Victor X. D. Yang, Erin Dyer, Ruchir A. Shah, Brenda M. Knowles, Jennifer Nichols, Jennifer Patterson, Krista A. Cope, Lee Dickerson, Katrina K. Barton, Kimberly Gray, Ticey N. Massengale, Melanie G. Miller, Cindy Simpson, Sabrina Walker, Chlin R. Tennyson-Yemm, Donald Frei, Richard J. on, Benjamin Atchie, Ian A. Kaminsky, Duandelyn C. Wilson, Nicolle L. Schraeder, Eric J. Arias, Lisa M. Kodis, Mark E. Talley, Alex A. Edinger, Tiffany C. Talley, Ita P. Dempsey, Laurie Williams, Scott A. Williams, Sonny Kupniewski, Brad K. Fasbinder, Joanna M. Snead, Hana Choe, Larami Mackenzie, David C. Weisman, Osman Kozak, Qaisar A. Shah, Dan Gzesh, Kandan Kulandaivel, John Khoury, Brad Klein, Patricia Bussinger, Lisa R. Griffin, Ashley L. DePalmo, Cynthia Oliva, Ashutosh P. Jadhav, Tudor G. Jovin, Cynthia L. Kenmuir, Brian T. Jankowitz, Bradley A. Gross, Marcelo Rocha, Matthew Starr, Merritt Brown, Chrstine Hawkes, Kavit Shah, Danoushka Tememe, Gregory Walker, Pratit Patel, Bradley G. Klein, Habibullah Ziayee, Kaustubh Limaye, Lisa Baxendell, Vicki Glichrist, Patricia Feineigle, Kelsea Toseki Haibach, Cathy Van Every, Shasvat Desai, Maryam Zulfiqar, Linda Gibson‐Young, Sean P. Barrett, David Turkel‐Parrella, Karthikeyan Arcot, Steven DiCrescento, Jeffrey Farkas, Gregory Filipowski, Jennifer Frontera, Danielle Joset, Jeremy Liff, Erica Scher, Cameron G. McDougall, Cheryl E. Kelly, Akshal Patel, Stephen J. 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, Hans Christoph Stretz, 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, Hyungjong Park, 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, Jennifer Cranefield, 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 · 发表于：Neurology · 年份：2025 · DOI：10.1212/wnl.0000000000213619 · 被引用次数：12 · 研究领域：Acute Ischemic Stroke Management、Frailty in Older Adults、Stroke Rehabilitation and Recovery

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 infar...