A recent cohort study, delving into the Safety and Efficacy of Nerinetide (NA-1) in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) trial, highlights the intricate relationship between age, neuroimaging markers of brain frailty, and post-thrombectomy outcomes in ischemic stroke patients. The findings reveal that 85.1% of the association between age and 90-day functional outcomes after thrombectomy is mediated by neuroimaging markers of frailty. These markers include brain atrophy, chronic infarcts, and small vessel disease observed on routine computed tomography images.
Key Findings:
- The study involved a cohort of 1102 patients with acute ischemic stroke undergoing endovascular thrombectomy.
- Neuroimaging markers of frailty, such as brain atrophy, chronic infarcts, and small vessel disease, mediated 85.1% of the total association of age with 90-day functional outcome after thrombectomy.
- Structural equation modeling (SEM) was utilized to create latent variables, combining various observable measures of brain frailty.
- The mediation by neuroimaging frailty suggests that brain changes, visible on routine computed tomography images, play a crucial role in predicting poststroke outcomes.
- The study emphasizes the importance of considering neuroimaging markers of frailty, rather than relying solely on chronological age, in clinical practice and future trials.
Implications:
- The findings underscore the need to move beyond chronological age when predicting outcomes after stroke.
- Incorporating neuroimaging markers of frailty in outcome predictions and trial analyses is recommended to avoid confounding treatment effects.
- Brain frailty features, including atrophy and small vessel disease, should be considered in patient evaluation and selection for interventions like thrombectomy.
- Future trials should explore the inclusion of neuroimaging-derived brain frailty as an adjusting variable or for stratification in randomization processes.
Conclusion: This study unveils the hidden impact of brain frailty, as revealed by neuroimaging markers, in mediating the association between age and post-thrombectomy outcomes in ischemic stroke patients. By emphasizing the importance of considering these frailty features, the research paves the way for more nuanced predictions and tailored interventions for stroke patients, moving beyond the limitations of chronological age alone.