{
  "abstract": "Background Up to half of patients with acute ischemic stroke (AIS) achieving successful reperfusion after endovascular thrombectomy (EVT) remain dependent. Although global atrophy may influence recovery, the prognostic value of regional atrophy patterns and white matter (WM) lesions remains uncertain.Methods We retrospectively included consecutive AIS patients achieving successful reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2b–3) after EVT at a comprehensive stroke center (2015–2023). Baseline CT was used to rate medial temporal atrophy (MTA), parietal atrophy (Koedam; antero-posterior index (API)), global cortical atrophy-frontal (GCA-F), and white matter lesions (Fazekas scale). The primary outcome was a composite measure of futile recanalization: functional dependence (modified Rankin Scale (mRS) >2), mRS worsening if premorbid mRS>2, or death. The secondary outcome was the ordinal shift across the mRS distribution. Associations between visual rating scales and outcomes were assessed using multivariable logistic and proportional-odds models, with sex-stratified and interaction analyses.Results A total of 450 AIS patients (mean age 73.6±14.0 years; 53.8% females; n=406 anterior circulation) were included. In anterior circulation stroke, parietal and frontal atrophy scales were independently associated with poor outcome: Koedam (adjusted OR (aOR) 2.19, 95% CI 1.32 to 3.63), GCA-F (aOR 1.90, 95% CI 1.11 to 3.26), and API-positivity (aOR 2.27, 95% CI 1.36 to 3.81). Periventricular and basal ganglia Fazekas scores were associated with poor outcome in univariate analyses but lost significance after multivariable adjustment.Conclusions Parietal and frontal atrophy are independently associated with the risk of futile recanalization after EVT. CT-based regional atrophy ratings could enhance individualized risk stratification and support treatment selection.",
  "authors": [
    {
      "affiliations": [
        "Department of Medicine and Surgery, University of Parma, Parma, Italy",
        "Department of General and Specialist Medicine, Neurology Unit, University Hospital of Parma, Parma, Italy",
        "Department of Neurobiology, Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Alessandro Zilioli"
    },
    {
      "affiliations": [
        "Department of Medicine and Surgery, University of Parma, Parma, Italy"
      ],
      "name": "Gabriele Busi"
    },
    {
      "affiliations": [
        "Stroke Care Program, Emergency Department, University Hospital of Parma, Parma, Italy"
      ],
      "name": "Antonio Genovese"
    },
    {
      "affiliations": [
        "Department of Medicine and Surgery, University of Parma, Parma, Italy"
      ],
      "name": "Giulia Avola"
    },
    {
      "affiliations": [
        "Department of Neurosciences, Neurology Unit, ASST Ospedale Cremona, Cremona, Italy"
      ],
      "name": "Marco Cesare Angeli"
    },
    {
      "affiliations": [
        "Department of Medicine and Surgery, University of Parma, Parma, Italy"
      ],
      "name": "Chiara Ferraro"
    },
    {
      "affiliations": [
        "Department of Medicine and Surgery, University of Parma, Parma, Italy"
      ],
      "name": "Lorenzo Corradi"
    },
    {
      "affiliations": [
        "Department of Medicine and Surgery, University of Parma, Parma, Italy"
      ],
      "name": "Beatrice Pancaldi"
    },
    {
      "affiliations": [
        "Department of General and Specialist Medicine, Neurology Unit, University Hospital of Parma, Parma, Italy"
      ],
      "name": "Marco Spallazzi"
    },
    {
      "affiliations": [
        "Stroke Care Program, Emergency Department, University Hospital of Parma, Parma, Italy"
      ],
      "name": "Giorgia Abrignani"
    },
    {
      "affiliations": [
        "Stroke Care Program, Emergency Department, University Hospital of Parma, Parma, Italy"
      ],
      "name": "Maria Claudia Trapasso"
    },
    {
      "affiliations": [
        "Stroke Care Program, Emergency Department, University Hospital of Parma, Parma, Italy"
      ],
      "name": "Lilia Latte"
    },
    {
      "affiliations": [
        "Stroke Care Program, Emergency Department, University Hospital of Parma, Parma, Italy"
      ],
      "name": "Paola Castellini"
    },
    {
      "affiliations": [
        "Department of Neurobiology, Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden",
        "Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK"
      ],
      "name": "Eric Westman"
    },
    {
      "affiliations": [
        "Department of Diagnostics, Neuroradiology Unit, University Hospital of Parma, Parma, Italy"
      ],
      "name": "Davide Cerasti"
    },
    {
      "affiliations": [
        "Department of Diagnostics, Neuroradiology Unit, University Hospital of Parma, Parma, Italy"
      ],
      "name": "Giulia Capurri"
    },
    {
      "affiliations": [
        "Department of Diagnostics, Neuroradiology Unit, University Hospital of Parma, Parma, Italy"
      ],
      "name": "Roberta Partesano"
    },
    {
      "affiliations": [
        "Department of Diagnostics, Neuroradiology Unit, University Hospital of Parma, Parma, Italy"
      ],
      "name": "Enrico Epifani"
    },
    {
      "affiliations": [
        "Department of Diagnostics, Neuroradiology Unit, University Hospital of Parma, Parma, Italy"
      ],
      "name": "Roberto Menozzi"
    },
    {
      "affiliations": [
        "Department of Medicine and Surgery, University of Parma, Parma, Italy",
        "Stroke Care Program, Emergency Department, University Hospital of Parma, Parma, Italy"
      ],
      "name": "Alessandro Pezzini"
    }
  ],
  "title": "Regional brain atrophy, white matter lesions, and functional outcome after endovascular thrombectomy for acute ischemic stroke",
  "uid": "03828036-f761-5fbb-a2f8-e014b88f134f"
}