Objective:

To evaluate how territory-specific brain health across distinct vascular territories, measured through effective reserve (eR), influence functional outcomes in patients with acute ischemic stroke (AIS).

Background:

Brain health is an important biomarker of post-stroke outcomes. While global measures of brain health are increasingly investigated, spatial differences affecting outcomes remain unknown.

Design/Methods:

We analyzed AIS survivors from the GASROS cohort (single center; 2003-2011) with white matter hyperintensity (WMH), combined gray and white matter (GMWM), and acute lesion outlines from available routine clinical imaging data. WMH and GMWM volumes were stratified by each supratentorial vascular territory (atlas based; anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA)). We quantified brain health through eR using structural equation modeling, incorporating GMWM and WMH volumes for each territory, as well as age. Contributions of each territory to eR were estimated using the path-coefficients for each territory’s volumetric markers. Ordinal regression models were fitted to assess the effect of territory-specific brain health on functional outcomes measured by the modified Rankin Scale (mRS; 0-5) at 90 days post-stroke, while accounting for acute lesion load, sex, hypertension, diabetes, and smoking. 

Results:

Conclusions:

Spatial patterns of brain health significantly impact functional outcome following AIS, suggesting that territory-specific brain health metrics are key biomarkers for stroke prognostication models.