Sven P R Luijten1, Daniel Bos2, Kars C J Compagne2, Lennard Wolff2, Charles B L M Majoie2, Yvo B W E M Roos2, Wim H van Zwam2, Robert J van Oostenbrugge2, Diederik W J Dippel2, Aad van der Lugt2, Adriaan C G M van Es2. 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.
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.
RCT Entities:
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.
Authors: Sven PR Luijten; Kars CJ Compagne; Adriaan CGM van Es; Yvo BWEM Roos; Charles BLM Majoie; Robert J van Oostenbrugge; Wim H van Zwam; Diederik WJ Dippel; Frank J Wolters; Aad van der Lugt; Daniel Bos Journal: Int J Stroke Date: 2021-10-28 Impact factor: 6.948