Brain atrophy is associated with an increased mortality rate in elderly trauma patients and in patients treated with mechanical thrombectomy for acute ischaemic stroke. In the setting of ischaemic stroke, the association between brain atrophy and death is stronger than that of sarcopenia. It has previously been shown that lower masseter area, as a marker of sarcopenia, is linked to lower survival after carotid endarterectomy (CEA). The aim of this study was to investigate whether brain atrophy is also associated with long term mortality in patients undergoing CEA.
A cohort of patients treated with CEA between 2004 and 2010 was retrieved from the Tampere University Hospital vascular registry and those with available pre-operative computed tomography (CT) imaging were analysed retrospectively. CT images were evaluated for brain atrophy index (BAI) and masseter muscle surface area and density. The association between BAI and mortality was investigated with Cox regression.
Two hundred and thirty-three patients with a median (interquartile range [IQR]) age of 71 years (64.0, 77.0) were included. Most patients were operated on for symptomatic stenosis (n = 203; 87.1%). The median (IQR) duration of follow up was 115.0 months (66.0, 153.0), and 155 patients (66.5%) died during follow up. BAI was statistically significantly correlated with age (r = .489), average masseter density (r = –.202), and smoking (r = –.186; all p <.005). Increased BAI was statistically significantly associated with overall mortality (hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.25 – 1.68, per one standard deviation [SD] increase) in the univariable analysis, and the association remained (HR 1.23, 95% CI 1.04 – 1.46, per one SD increase) in the multivariable models. Age, peripheral artery disease, and chronic obstructive pulmonary disease were also independently associated with mortality. The optimal cutoff value for BAI was 0.133.
Brain atrophy independently predicts the long term post-operative mortality rate after CEA in a cohort containing mainly symptomatic patients. Future studies are needed to validate the results in prospective settings and in asymptomatic patients.
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Published online: October 06, 2022
Accepted: October 2, 2022
Received: October 13, 2021
© 2022 Published by Elsevier B.V. on behalf of European Society for Vascular Surgery.
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- Measurement of the Brain Atrophy Index To Predict Mortality: a ‘No-Brainer’?European Journal of Vascular and Endovascular SurgeryVol. 65Issue 3
- PreviewIn this issue of the European Journal of Vascular and Endovascular Surgery, Lauksia et al. present a multivariable analysis of pre-operative brain atrophy as a predictor of long term mortality after carotid endarterectomy (CEA).1 In the field of carotid revascularisation, various prediction models have been developed in the past to assist stratifying patients into groups at high and low risk of peri-procedural complications or long term stroke risk. An evaluation of the external performance of 23 short and seven long term outcome models showed that these models do not reliably predict outcome after carotid revascularisation, and concluded that new prediction models are needed.