White Matter Lesions and Outcomes After Endovascular Treatment for Acute Ischemic Stroke: MR CLEAN Registry Results
Authors: Uniken Venema Simone M. , Postma Alida A. , van den Wijngaard Ido R. , Vos Jan Albert , Lingsma Hester F. , Bokkers Reinoud P.H. , Hofmeijer Jeannette , Dippel Diederik W.J. , Majoie Charles B. , van der Worp H. Bart , Lugt Aad van der , Roos Yvo B.W.E.M. , van Oostenbrugge Robert J. , van Zwam Wim H. , Boiten Jelis , Jansen Ivo G.H. , Mulder Maxim J.H.L. , Goldhoorn Robert- Jan B. , Compagne Kars C.J. , Kappelhof Manon , Brouwer Josje , den Hartog Sanne J. , Hinsenveld Wouter H. , Roozenbeek Bob , Lugt Aad van der , van Es Adriaan C.G.M. , Roos Yvo B.W.E.M. , Emmer Bart J. , Coutinho Jonathan M. , Schonewille Wouter J. , Wermer Marieke J.H. , van Walderveen Marianne A.A. , Staals Julie , van Oostenbrugge Robert J. , van Zwam Wim H. , Martens Jasper M. , Lycklama à Nijeholt Geert J. , Boiten Jelis , de Bruijn Sebastiaan F. , van Dijk Lukas C. , Lo Rob H. , van Dijk Ewoud J. , Boogaarts Hieronymus D. , de Vries J. , de Kort Paul L.M. , van Tuijl Julia , Peluso Jo P. , Fransen Puck , van den Berg Jan S.P. , van Hasselt Boudewijn A.A.M. , Aerden Leo A.M. , Dallinga René J. , Uyttenboogaart Maarten , Eschgi Omid , Schreuder Tobien H.C.M.L. , Heijboer Roel J.J. , Keizer Koos , Yo Lonneke S.F. , den Hertog Heleen M. , Sturm Emiel J.C. , Brouwers Paul J.A.M. , van Zwam Wim H. , van der Lugt Aad , Lycklama à Nijeholt Geert J. , van Walderveen Marianne A.A. , Sprengers Marieke E.S. , Jenniskens Sjoerd F.M. , van den Berg René , Yoo Albert J. , Beenen Ludo F.M. , Roosendaal Stefan D. , van der Kallen Bas F.W. , van Es Adriaan C.G.M. , Emmer Bart J. , Martens Jasper M. , Yo Lonneke S.F. , Bot Joost , van Doormaal Pieter-Jan , Meijer Anton , Ghariq Elyas , van Proosdij Marc P. , Krietemeijer G. Menno , Peluso Jo P. , Boogaarts Hieronymus D. , Lo Rob , Gerrits Dick , Dinkelaar Wouter , Appelman Auke P.A. , Hammer Bas , Pegge Sjoert , van der Hoorn Anouk , Vinke Saman , van der Lugt Aad , Roos Yvo B.W.E.M. , van Oostenbrugge Robert J. , van Zwam Wim H. , Lycklama à Nijeholt Geert J. , Boiten Jelis , Schonewille Wouter J. , Martens Jasper M. , Lo Rob H. , van Oostenbrugge Robert J. , Flach H. Zwenneke , el Ghannouti Naziha , Sterrenberg Martin , Pellikaan Wilma , Sprengers Rita , Elfrink Marjan , Simons Michelle , Vossers Marjolein , de Meris Joke , Vermeulen Tamara , Geerlings Annet , van Vemde Gina , Simons Tiny , Messchendorp Gert , Nicolaij Nynke , Bongenaar Hester , Bodde Karin , Kleijn Sandra , Lodico Jasmijn , Droste Hanneke , Wollaert Maureen , Verheesen Sabrina , Jeurrissen D. , Bos Erna , Drabbe Yvonne , Sandiman Michelle , Aaldering Nicoline , Zweedijk Berber , Vervoort Jocova , Ponjee Eva , Romviel Sharon , Kanselaar Karin , Barning Denn , Venema Esmee , Chalos Vicky , Geuskens Ralph R. , van Straaten Tim , Ergezen Saliha , Harmsma Roger R.M. , Muijres Daan , de Jong Anouk , Berkhemer Olvert A. , Boers Anna M.M. , Huguet J. , Groot P.F.C. , Mens Marieke A. , van Kranendonk Katinka R. , Treurniet Kilian M. , Tolhuisen Manon L. , Alves Heitor , Weterings Annick J. , Kirkels Eleonora L.F. , Voogd Eva J.H.F. , Schupp Lieve M. , Collette Sabine L. , Groot Adrien E.D. , LeCouffe Natalie E. , Konduri Praneeta R. , Prasetya Haryadi , Arrarte-Terreros Nerea , Ramos Lucas A. 
Published: June 2021

Background:
Cerebral white matter lesions (WMLs) have been associated with a greater risk of poor functional outcome after ischemic stroke. We assessed the relations between WML burden and radiological and clinical outcomes in patients treated with endovascular treatment in routine practice.

Methods:
We analyzed data from the MR CLEAN Registry (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischaemic Stroke in the Netherlands)—a prospective, multicenter, observational cohort study of patients treated with endovascular treatment in the Netherlands. WMLs were graded on baseline noncontrast computed tomography using a visual grading scale. The primary outcome was the score on the modified Rankin Scale at 90 days. Secondary outcomes included early neurological recovery, successful reperfusion (extended Thrombolysis in Cerebral Infarction ≥2b), futile recanalization (modified Rankin Scale score ≥3 despite successful reperfusion), and occurrence of symptomatic intracranial hemorrhage. We used multivariable logistic regression models to assess associations between WML severity and outcomes, taking the absence of WML on noncontrast computed tomography as the reference category.

Results:

Of 3180 patients included in the MR CLEAN Registry between March 2014 and November 2017, WMLs were graded for 3046 patients and categorized as none (n=1855; 61%), mild (n=608; 20%), or moderate to severe (n=588; 19%). Favorable outcome (modified Rankin Scale score, 0–2) was achieved in 838 patients (49%) without WML, 192 patients (34%) with mild WML, and 130 patients (24%) with moderate-to-severe WML. Increasing WML grades were associated with a shift toward poorer functional outcome in a dose-dependent manner (adjusted common odds ratio, 1.34 [95% CI, 1.13–1.60] for mild WML and 1.67 [95% CI, 1.39–2.01] for moderate-to-severe WML;
P
trend
, <0.001). Increasing WML grades were associated with futile recanalization (
P
trend
, <0.001) and were inversely associated with early neurological recovery (
P
trend
, 0.041) but not with the probability of successful reperfusion or symptomatic intracranial hemorrhage.

Conclusions:
An increasing burden of WML at baseline is associated with poorer clinical outcomes after endovascular treatment for acute ischemic stroke but not with the probability of successful reperfusion or symptomatic intracranial hemorrhage.