Association of White Matter Lesions and Outcome After Endovascular Stroke Treatment

Sven P. R. Luijten*, Daniel Bos, Kars C. J. Compagne, Lennard Wolff, Charles B. L. M. Majoie, Yvo B. W. E. M. Roos, Wim H. van Zwam, Robert J. van Oostenbrugge, Diederik W. J. Dippel, Aad van der Lugt, Adriaan C. G. M. van Es, MR CLEAN Trial Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objective

To 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.

Methods

We 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.

Results

We 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).

Conclusions

WML are associated with poor functional outcome after AIS, but do not modify the effect of EVT.

Classification of Evidence

Prognostic 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.

Original languageEnglish
Pages (from-to)E333-E342
Number of pages10
JournalNeurology
Volume96
Issue number3
DOIs
Publication statusPublished - 19 Jan 2021

Keywords

  • ACUTE ISCHEMIC-STROKE
  • CT
  • INFARCT VOLUME
  • INTRAARTERIAL TREATMENT
  • LEUKOARAIOSIS PREDICTS
  • RECANALIZATION
  • REPERFUSION
  • SCORE
  • THROMBECTOMY
  • TRIAL
  • CIRCULATION

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