Original Investigation

Brain Frailty and Functional Outcomes After Thrombolysis for Acute Ischemic Stroke

JAMA Network Open 10.1001/jamanetworkopen.2025.34941

September 30, 2025 at 11:00 AM EDT

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Are neuroimaging markers of brain frailty associated with functional outcomes in patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis?In this cohort study of 1568 patients with AIS, the severity of white matter changes, cortical atrophy, and a total brain frailty score capturing the aggregate burden were each associated with worse functional outcomes at 90 days.These findings suggest that brain frailty assessment on baseline neuroimaging using clinical rating scales provides prognostic information for clinicians and patients regarding functional outcomes after reperfusion therapies for AIS, including intravenous thrombolysis with alteplase or tenecteplase.

Corresponding Author: Aravind Ganesh, MD, DPhil(Oxon), Health and Medical Research Building, Room 103, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada (aganesh@ucalgary.ca).

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