The following is a summary of “Association of Brain Atrophy With Functional Outcome and Recovery Trajectories After Thrombectomy: Post-Hoc Analysis of the ESCAPE-NA1 Trial,” published in the August 2023 issue of Neurology by Benali et al.
Brain frailty can hinder stroke patients’ coping and recovery regardless of age. Researchers initiated a retrospective study to explore the influence of brain atrophy on functional outcomes evaluated at various post-EVT time points.
They scrutinized the ESCAPE-NA1 trial, assessing CT-imaging data for cortical atrophy via the Global Cortical Atrophy (GCA) scale, encompassing region-specific scales. Subcortical atrophy was evaluated using the intercaudate-distance-to-inner-table-width (CC/IT) ratio. The primary outcome was 90-day mRS using ordinal shift analysis, with the secondary outcome tracking mRS scores over time. Adjustments considered age, sex, baseline NIHSS, final infarct volume, stroke laterality, total Fazekas score, and nerine tide-alteplase interaction. Sensitivity analyses focused on patients with accessible MRI data.
The results showed 1,102 subjects (mean age: 69.5±13.7 years; 554 men), 74% exhibited GCA=0, 20% GCA=1, and 6% GCA=2/3. The median CC/IT ratio was 0.12 (IQR 0.10-0.15). Cortical atrophy (GCA≥1 vs. GCA=0) correlated with worse 90-day of Rankin Scale (acOR=1.62 [95%CI: 1.22-2.16]; P=0.001), reduced 90-day mRS0-2 rates (aOR=0.65 [95%CI: 0.45-0.94]; P=0.022), and higher mortality (aOR=2.12 [95%CI: 1.28-3.5]; P=0.003). Subcortical atrophy related to worse 90-day mRS (acOR [per 0.01 increase in CC/IT ratio] = 1.07 [95%CI: 1.04-1.11]; P<0.001) and lower 90-day mRS0-2 rates (aOR=0.92 [95%CI: 0.88-0.97]; P=0.001). The mRS measurements varied during follow-up, indicating worse scores for higher grades (P<0.001), GCA=1, mRS remained high at 30 days (adjusted difference=0.41 [95%CI: 0.18-0.65]) and persisted at 90 days (adjusted difference=0.72 [95%CI: 0.49-0.95]), compared with GCA=0. Similar patterns were observed for cortical and subcortical atrophy; 41% (26/63) and 45% (124/274) (GCA=2/3 and highest CC/IT ratio quartile) achieved good functional outcomes (mRS0-2), compared to 66.4% (539/812) with no cortical atrophy and 76% (209/274) in the lowest CC/IT ratio quartile.
They concluded EVT participants with brain atrophy showed less favorable stroke recovery and worse 90-day functional outcomes, highlighting the need for better recovery expectations.