2026-05-05T19:46:47Zhttps://uvadoc.uva.es/oai/request

oai:uvadoc.uva.es:10324/644382025-02-20T09:45:17Zcom_10324_1179com_10324_931com_10324_894col_10324_1306

00925njm 22002777a 4500 dc Pedraza, María I. author de Lera, Mercedes author Bos, Daniel author Calleja Sanz, Ana Isabel author Cortijo, Elisa author Gómez Vicente, Beatriz author Reyes, Javier author Coco Martín, María Begoña author Calonge Cano, Teodoro author Agulla, Jesús author Martínez-Pías, Enrique author Talavera, Blanca author Pérez Fernández, Santiago author Schüller, Miguel author Galván, Jorge author Castaño, Miguel author Martínez-Galdámez Ruiz, Mario author Arenillas Lara, Juan Francisco author 2020 Background Brain atrophy is suggested to impair the potential for functional recovery after acute ischemic stroke. We assessed whether the effect of endovascular treatment is modified by brain atrophy in patients with acute ischemic stroke due to large vessel occlusion. Methods We used data from MR CLEAN, a multicenter trial including patients with acute ischemic stroke due to anterior circulation large vessel occlusion randomized to endovascular treatment plus medical care (intervention) versus medical care alone (control). We segmented total brain volume (TBV) and intracranial volume (ICV) on baseline non-contrast computed tomography (n = 410). Next, we determined the degree of atrophy as the proportion of brain volume in relation to head size (1 - TBV/ICV) × 100%, analyzed as continuous variable and in tertiles. The primary outcome was a shift towards better functional outcome on the modified Rankin Scale expressed as adjusted common odds ratio. Treatment effect modification was tested using an interaction term between brain atrophy (as continuous variable) and treatment allocation. Results We found that brain atrophy significantly modified the effect of endovascular treatment on functional outcome (P for interaction = 0.04). Endovascular treatment led to larger shifts towards better functional outcome in the higher compared to the lower range of atrophy (adjusted common odds ratio, 1.86 [95% CI: 0.97-3.56] in the lowest tertile vs. 1.97 [95% CI: 1.03-3.74] in the middle tertile vs. 3.15 [95% CI: 1.59-6.24] in the highest tertile). Conclusion Benefit of endovascular treatment is larger in the higher compared to the lower range of atrophy, demonstrating that advanced atrophy should not be used as an argument to withhold endovascular treatment. Stroke. 2020 May;51(5):1514-1521 0039-2499 https://uvadoc.uva.es/handle/10324/64438 10.1161/STROKEAHA.119.028511 1514 5 1521 Stroke 51 1524-4628 Brain atrophy and the risk of futile endovascular reperfusion in acute ischemic stroke