This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
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.
Glossary
- acOR=
- adjusted common odds ratio;
- AIS=
- acute ischemic stroke;
- ASPECTS=
- Alberta Stroke Program Early CT Score;
- CI=
- confidence interval;
- cSVD=
- cerebral small vessel disease;
- CTA=
- CT angiography;
- DSA=
- digital subtraction angiography;
- EVT=
- endovascular treatment;
- ICAC=
- intracranial carotid artery calcification;
- IVT=
- IV thrombolysis;
- LVO=
- large vessel occlusion;
- MR CLEAN=
- Multicenter Randomized Clinical Trial of Endovascular treatment of Acute Ischemic Stroke in the Netherlands;
- mRS=
- modified Rankin Scale;
- mTICI=
- modified Treatment in Cerebral Ischemia;
- NCCT=
- noncontrast CT;
- NIHSS=
- NIH Stroke Scale;
- sICH=
- symptomatic intracranial hemorrhage;
- VSS=
- Van Swieten Scale;
- WML=
- white matter lesion
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
MR CLEAN trial investigators are listed at links.lww.com/WNL/B250.
Class of Evidence: NPub.org/coe
- Received January 15, 2020.
- Accepted in final form August 12, 2020.
- © 2020 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Topics Discussed
Alert Me
Recommended articles
How temporal evolution of intracranial collaterals in acute stroke affects clinical outcomes
Association of Pediatric ASPECTS and NIH Stroke Scale, Hemorrhagic Transformation, and 12-Month Outcome in Children With Acute Ischemic Stroke
Endovascular vs medical management of acute ischemic stroke
Developing practice recommendations for endovascular revascularization for acute ischemic stroke