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

doi:10.1212/WNL.0000000000010994

Association of White Matter Lesions and Outcome After Endovascular Stroke Treatment

Neurology. 2021 Jan 19;96(3):e333-e342. doi: 10.1212/WNL.0000000000010994. Epub 2020 Oct 12.

Collaborators

MR CLEAN trial investigators:
Diederik Dippel, Aad van de Lugt, Charles B L M Majoie, Yvo B W E M Roos, Robert van Oostenbrugge, Wim H van Zwam, Olvert A Berkhemer, Puck S S Fransen, Debbie Beumer, Lucie A van den Berg, Wouter J Schonewille, Jan Albert Vos, Paul J Nederkoorn, Marieke J H Werme, Marianne A A van Walderveen, Julie Staals, Jeanette Hofmeijer, Jacques A van Oostayen, Geert J Lycklama À Nijeholt, Jelis Boiten, Patrick A Brouwer, Bart J Emmer, Sebastiaan F de Bruijn, Lukas C van Dijk, L Jaap Kappelle, Rob H Lo, Ewoud J van Dijk, Joost de Vries, Paul L M de Kort, Jan S P van den Berg, Willem Jan J van Rooij, Boudewijn A A M van Hasselt, Leo A M Aerden, René J Dallinga, Marieke C Visser, Joseph C J Bot, Patrick C Vroomen, Omid Eshghi, Tobien H C M L Schreuder, Roel J J Heijboer, Koos Keizer, Alexander V Tielbeek, Heleen M den Hertog, Dick G Gerrits, Renske M van den Berg-Vos, Giorgos B Karas, Henk A Marquering, Ludo F Beenen, Marieke E S Sprengers, Sjoerd F M Jenniskens, Gerson Albert J Yoo, Peter J Koudstaal, Zwenneke H Flach, Ewout W Steyerberg, Hester F Lingsma

Affiliations

¹ From the Departments of Radiology and Nuclear Medicine (S.P.R.L., D.B., K.C.J.C., L.W., A.v.d.L., A.C.G.M.v.E.), Neurology (K.C.J.C., D.W.J.D.), and Epidemiology (D.B.), Erasmus MC, University Medical Center, Rotterdam; Departments of Radiology (C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Amsterdam University Medical Center, Location AMC, University of Amsterdam; and Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands. s.luijten@erasmusmc.nl.
² From the Departments of Radiology and Nuclear Medicine (S.P.R.L., D.B., K.C.J.C., L.W., A.v.d.L., A.C.G.M.v.E.), Neurology (K.C.J.C., D.W.J.D.), and Epidemiology (D.B.), Erasmus MC, University Medical Center, Rotterdam; Departments of Radiology (C.B.L.M.M.) and Neurology (Y.B.W.E.M.R.), Amsterdam University Medical Center, Location AMC, University of Amsterdam; and Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands.

PMID: 33046611
DOI: 10.1212/WNL.0000000000010994

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.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Brain / pathology*
Endovascular Procedures
Female
Humans
Ischemic Stroke / pathology
Ischemic Stroke / therapy*
Male
Middle Aged
Prognosis
Registries
Treatment Outcome
White Matter / pathology*

Associated data

NTR/NTR1804
ISRCTN/ISRCTN10888758