Predicting Functional Outcome after Mechanical Thrombectomy Using a Structural Equation Model of Age and Brain Frailty Based on Pre-thrombectomy MRI
Yoonkyung Lee1, Junho Sung2, Seungho Lee3, Dae-Hyun Kim1, Jung Hwa Seo1, Jin-Heon Jeong1, Jae-Kwan Cha1
1College Of Medicine, Dong-A University, 2Neurology, 3Department of Preventive Medicine, College Of Medicine, Dong-A University
Objective:

Brain frailty assessed by pre-treatment MRI to evaluate its impact on 3month functional outcomes in anterior circulation AIS patients undergoing MT.

Background:
In patients undergoing mechanical thrombectomy (MT) for anterior circulation large vessel occlusion (LVO) in acute ischemic stroke (AIS), the role of brain frailty assessed via pre-treatment MRI remains unclear. 
Design/Methods:

We retrospectively analyzed 264 patients with anterior circulation large vessel occlusion (LVO) who underwent mechanical thrombectomy (MT). Brain frailty was operationalized as a latent construct comprising global cortical atrophy, Fazekas scores of periventricular and deep white matter, and the presence of old cortical infarctions and lacunes. Structural equation modeling (SEM) was performed to evaluate the direct and indirect effects of age on 3-month functional outcome, defined by the modified Rankin Scale (mRS), with brain frailty specified as the mediating factor.

Results:

Brain frailty was directly associated with poor 3-month outcome (β = 0.36, p = 0.003). Age was positively associated with brain frailty (β = 0.17, p < 0.001) and showed a significant indirect effect on poor outcome through brain frailty (β = 0.054, 95% CI 0.028–0.080, p < 0.001). The direct effect of age on outcome was not significant, supporting a full mediation model. Additional analyses showed that higher NIHSS, severe hypoperfusion intensity ratio, and failed reperfusion were independently related to poor outcome. Logistic regression confirmed that brain frailty was significantly associated with poor functional outcome (OR = 2.53, 95% CI 1.14–5.63, p = 0.023).

Conclusions:

Brain frailty on pre-treatment MRI independently predicted poor 3-month outcome after mechanical thrombectomy for anterior circulation AIS, providing prognostic value beyond reperfusion status and age. Considering brain frailty may improve outcome prediction in clinical practice.

10.1212/WNL.0000000000213285
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