Sarcopenia measurement via temporal muscle thickness as a predictor of futile stroke thrombectomy

PURPOSE Sarcopenia is associated with worse outcome in stroke patients and temporalis muscle thickness (TMT) has been proposed as a surrogate marker. The objective of this study is to determine whether, among elderly stroke patients who undergo technically successful thrombectomy, the presence of sarcopenia via TMT predicts poor functional outcomes. METHODS A retrospective chart review of patients age > 65 years with angiographic evidence of large vessel occlusion who underwent thrombectomy at a comprehensive stroke center was performed. TMT was measured independently by 2 neuroradiologists using axial 3 to 5 mm multiplanar reconstruction from nonenhanced sequence of the admission head CT. RESULTS Between 2015–2024, 270 stroke patients > 65 years of age underwent mechanical thrombectomy with TICI 2b/3 recanalization. Mean age and admission NIHSS were 77.1 years and 18.3 respectively. Patients were divided into 3 groups based on TMT: < 3.775 mm, 3.775–6.125 mm, and above ≥ 6.125 mm. As TMT increased, the proportion of patients with mRS 0–2 increased (26.15% vs. 37.96% vs. 50%, respectively; p = 0.02). Spearman correlation between TMT and mRS at 90 days showed a significant negative correlation (correlation coefficient= -0.13, p = 0.030). Image interpretation validity was demonstrated by a 77.0% agreement among both board certified neuroradiologists in the choice of which CT slice to calculate TMT. CONCLUSION Our study shows that despite sufficient recanalization, temporalis muscle thickness in patients age > 65, correlated with futile recanalization. TMT, as a surrogate for sarcopenia, may help in stroke thrombectomy triage, by providing additional information in addition to telephone interviews to determine prestroke disability.