TY - JOUR
T1 - Association of White Matter Lesions and Outcome After Endovascular Stroke Treatment
AU - Luijten, Sven P. R.
AU - Bos, Daniel
AU - Compagne, Kars C. J.
AU - Wolff, Lennard
AU - Majoie, Charles B. L. M.
AU - Roos, Yvo B. W. E. M.
AU - van Zwam, Wim H.
AU - van Oostenbrugge, Robert J.
AU - Dippel, Diederik W. J.
AU - van der Lugt, Aad
AU - van Es, Adriaan C. G. M.
AU - MR CLEAN Trial Investigators
N1 - Funding Information:
The MR CLEAN trial was partly funded by the Dutch Heart Foundation and by unrestricted grants from AngioCare BV, Medtronic/Covidien/EV3, MEDAC GmbH/LAMEPRO, Penumbra Inc., Stryker, and Top Medical/Concentric. MR CLEAN is registered under number NTR1804 in the Dutch trial register and under ISRCTN10888758 in the ISRCTN register.
Funding Information:
Sven P.R. Luijten, Daniel Bos, Kars C.J. Compagne, and Lennard Wolff report no disclosures. Charles B.L.M. Majoie reports that Amsterdam UMC received research grants from CVON/Dutch Heart Foundation, European Commission, TWIN Foundation, and Stryker; he is a shareholder of Nico-Lab. Yvo B.W.E.M. Roos reports that Amsterdam UMC received research grants form CVON/Dutch Heart Foundation and is a minor shareholder of Nico-Lab. Wim. H. van Zwam reports that Maastricht UMC received consultancy fees from Cerenovus and Stryker. Robert J. van Oostenbrugge reports no disclosures. Diederik W.J. Dippel reports that Erasmus MC received grants from the Dutch Heart Foundation, Dutch Brain Foundation, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, Stryker European Operations BV, Thrombolytic Science, LLC, Penumbra, Medtronic, and Cerenovus for new trials in acute stroke treatment. Aad van der Lugt reports that Erasmus MC received grants from the Dutch Heart Foundation, Dutch Brain Foundation, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, Stryker European Operations BV, Thrombolytic Science, LLC, Penumbra, Medtronic, and Cerenovus for new trials in acute stroke treatment. Adriaan C.G.M. van Es reports no disclosures. Go to Neurology.org/N for full disclosures.
Funding Information:
The MR CLEAN trial was partly funded by the Dutch Heart Foundation and by unrestricted grants from AngioCare BV, Medtronic/Covidien/EV3, MEDAC GmbH/LAMEPRO, Penumbra Inc., Stryker, and Top Medical/Concentric. MR CLEAN is registered under number NTR1804 in theDutch trial register and under ISRCTN10888758 in the ISRCTN register.
Publisher Copyright:
© American Academy of Neurology.
PY - 2021/1/19
Y1 - 2021/1/19
N2 - ObjectiveTo investigate the association between white matter lesions (WML) and functional outcome in patients with acute ischemic stroke (AIS) and the modification of the effect of endovascular treatment (EVT) by WML.MethodsWe used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trial and assessed severity of WML on baseline noncontrast CT imaging (NCCT; n = 473) according to the Van Swieten Scale. Poststroke functional outcome was assessed with the modified Rankin Scale. We investigated the association of WML with functional outcome using ordinal logistic regression models adjusted for age, sex, and other relevant cardiovascular and prognostic risk factors. In addition, an interaction term between treatment allocation and WML severity was used to assess treatment effect modification by WML.ResultsWe found an independent negative association between more severe WML and functional outcome (adjusted common odds ratio [acOR] 0.77 [95% confidence interval (CI) 0.66-0.90]). Patients with absent to moderate WML had similar benefit of EVT on functional outcome (acOR 1.93 [95% CI 1.31-2.84]) as patients with severe WML (acOR 1.95 [95% CI 0.90-4.20]). No treatment effect modification of WML was found (p for interaction = 0.85).ConclusionsWML are associated with poor functional outcome after AIS, but do not modify the effect of EVT.Classification of EvidencePrognostic accuracy. This study provides Class II evidence that for patients with AIS, the presence of WML on baseline NCCT is associated with worse functional outcomes.
AB - ObjectiveTo investigate the association between white matter lesions (WML) and functional outcome in patients with acute ischemic stroke (AIS) and the modification of the effect of endovascular treatment (EVT) by WML.MethodsWe used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trial and assessed severity of WML on baseline noncontrast CT imaging (NCCT; n = 473) according to the Van Swieten Scale. Poststroke functional outcome was assessed with the modified Rankin Scale. We investigated the association of WML with functional outcome using ordinal logistic regression models adjusted for age, sex, and other relevant cardiovascular and prognostic risk factors. In addition, an interaction term between treatment allocation and WML severity was used to assess treatment effect modification by WML.ResultsWe found an independent negative association between more severe WML and functional outcome (adjusted common odds ratio [acOR] 0.77 [95% confidence interval (CI) 0.66-0.90]). Patients with absent to moderate WML had similar benefit of EVT on functional outcome (acOR 1.93 [95% CI 1.31-2.84]) as patients with severe WML (acOR 1.95 [95% CI 0.90-4.20]). No treatment effect modification of WML was found (p for interaction = 0.85).ConclusionsWML are associated with poor functional outcome after AIS, but do not modify the effect of EVT.Classification of EvidencePrognostic accuracy. This study provides Class II evidence that for patients with AIS, the presence of WML on baseline NCCT is associated with worse functional outcomes.
KW - ACUTE ISCHEMIC-STROKE
KW - CT
KW - INFARCT VOLUME
KW - INTRAARTERIAL TREATMENT
KW - LEUKOARAIOSIS PREDICTS
KW - RECANALIZATION
KW - REPERFUSION
KW - SCORE
KW - THROMBECTOMY
KW - TRIAL
KW - CIRCULATION
U2 - 10.1212/WNL.0000000000010994
DO - 10.1212/WNL.0000000000010994
M3 - Article
C2 - 33046611
SN - 0028-3878
VL - 96
SP - E333-E342
JO - Neurology
JF - Neurology
IS - 3
ER -