Background: Ischemic tolerance differs between white matter (WM) and grey matter. Timely reperfusion may result in preferential sparing of WM. We investigated if the degree of WM sparing after recanalization therapy has an impact on early neurological recovery and functional outcomes. Methods: Patients from ESCAPE trial were included if they had follow-up MRI brain. WM involvement was scored on a semiquantitative scale which divides hemispheric WM into twelve regions (Figure), adding one point for each area involved. Using receiver operating characteristics analysis and Youden J, optimum cutoff value of WM score for favorable outcome (90-day mRS≤2) was calculated and then used to classify patients into WM spared vs involved groups. Early neurological recovery was compared using difference in median 24-h NIHSS. Multivariable logistic regression was used to test the association between the WM score and outcome. Results: Among 108 patients, median WM score was 2 (IQR 1-4) in EVT (endovascular thrombectomy) arm (n= 70) and 3 (IQR 1-6) in control arm (n= 38). The threshold of ≤2 (WM spared) had sensitivity 69.1 and specificity of 69.8% for favorable outcome (AUC 0.74; 95% CI, 0.65 to 0.82; P<0.001). WM sparing was independently associated with favorable outcome after adjusting for age, baseline NIHSS, EVT use, cortical involvement, infarct volume and symptomatic hemorrhage (adjusted OR 5.34; 95% CI, 1.62-17.9, P=0.006). These patients had better neurological recovery (median 24-h NIHSS 4 in WMspared vs 11 in WMinvolved group; P <0.001) and lower infarct volumes (8 ml vs 47 ml; P <0.001). Patient with WMspared also had numerically lower incidence of malignant brain edema (0 vs 5.6%; P=0.24), intracerebral hemorrhage (symptomatic 0 vs 7.4%; P=0.12), and mortality (3.7 vs 11.1%; P=0.27) than WM involved group. Conclusion: White matter sparing was an independent predictor of early neurological recovery, and functional outcomes in the ESCAPE trial.