Impact of renal impairment on short-term outcomes following endovascular thrombectomy for acute ischemic stroke: A systematic review and meta-analysis

Jeon, Jin Pyeong; Chen, Chih‐Hao; Liu, Jianming; Hill, Michael D.; Zhang, Lei; Yang, Pengfei; Wang, Guoping; Cho, Bang‐Hoon; Kim, Joon‐Tae; Goyal, Mayank; Cho, Yong Jun; Chai, Chung Liang

doi:10.1177/17474930211047337

Cited by 8 publications

(9 citation statements)

References 45 publications

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“…Recently, a systematic review and meta-analysis by Jeon et al 38 came to similar conclusions to our study. They searched MEDLINE, EMBASE, and Google Scholar on 11 September 2020, and their study contained some unpublished data obtained by contacting the corresponding authors of potential studies.…”

Section: Discussionsupporting

confidence: 91%

Renal impairment and the prognosis of endovascular thrombectomy: a meta-analysis and systematic review

Wang

Xie

et al. 2022

Ther Adv Neurol Disord

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Background: The association between renal impairment (RI) and stroke outcome after endovascular thrombectomy (EVT) remains unclear, which limits the estimation of patient prognosis by clinicians involved in EVT decision-making. Purpose: This study aimed to investigate the association between RI and acute ischemic stroke (AIS) outcomes in patients treated with EVT. Methods: Studies involving the association between RI at admission and AIS outcomes after EVT were retrieved from the PubMed and Embase databases from their inception to 17 January 2022. A fixed-effects model was used to synthesize the data of the included studies. Sensitivity analysis was performed to identify the source of heterogeneity. Results: Overall, 11 studies, including 5053 patients with stroke receiving EVT, were included in the full analysis. In unadjusted analyses, RI was associated with 3-month poor functional outcome and mortality; the odds ratios (ORs) were 2.13 [10 studies; 95% confidence interval (CI), 1.77–2.56; I2 = 45%] and 2.42 (8 studies; 95% CI, 2.02–2.90; I2 = 58%), respectively. In adjusted analyses, the above associations remained significant; the OR of the 3-month poor functional outcome was 1.49 (5 studies; 95% CI, 1.17–1.90; I2 = 58%), and the OR of the 3-month mortality was 1.84 (6 studies; 95% CI, 1.45–2.33; I2 = 74%). Similar results were obtained in sensitivity analyses. Conclusion: Our results suggest that in patients with AIS who underwent EVT, RI at admission was associated with 3-month poor functional outcome and mortality.

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Section: Discussionsupporting

confidence: 91%

Renal impairment and the prognosis of endovascular thrombectomy: a meta-analysis and systematic review

Wang

Xie

et al. 2022

Ther Adv Neurol Disord

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“…21,22 Especially, despite randomized clinical trial can give some certainties to this gray area, previous trials could not answer this question because previous several legacy trials excluded the low-eGFR patients. 23 , In addition, most of the retrospective studies on the impact of low eGFR on the outcome after EVT included a small sample size and used a fixed reference for low eGFR (<30 or 60 mL/min per 1.73 m 2 ) without considering age-related or sex-related differences in eGFR. Furthermore, previous studies did not consider collateral status, occlusion site, or various comorbidities, including active cancer, which could affect the outcome after EVT.…”

Section: Discussionmentioning

confidence: 99%

Impact of Renal Function on Short-Term Outcome After Reperfusion Therapy in Patients With Ischemic Stroke

Park

Nam

Yoo

et al. 2022

Stroke

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BACKGROUND: A high and low estimated glomerular filtration rate (eGFR) could affect outcomes after reperfusion therapy for ischemic stroke. This study aimed to determine whether renal function based on eGFR affects mortality risk in patients with ischemic stroke within 6 months following reperfusion therapy. METHODS: This prospective registry–based cohort study included 2266 patients who received reperfusion therapy between January 2000 and September 2019 and were registered in the SECRET (Selection Criteria in Endovascular Thrombectomy and Thrombolytic Therapy) study or the Yonsei Stroke Cohort. A high and low eGFR were based on the Chronic Kidney Disease Epidemiology Collaboration equation and defined, respectively, as the 5th and 95th percentiles of age- and sex-specific eGFR. Occurrence of death within 6 months was compared among the groups according to their eGFR such as low, normal, or high eGFR. RESULTS: Of the 2266 patients, 2051 (90.5%) had a normal eGFR, 110 (4.9%) a low eGFR, and 105 (4.6%) a high eGFR. Patients with high eGFR were younger or less likely to have hypertension, diabetes, or atrial fibrillation than the other groups. Active cancer was more prevalent in the high-eGFR group. During the 6-month follow-up, there were 24 deaths (22.9%) in the high-eGFR group, 37 (33.6%) in the low-eGFR group, and 237 (11.6%) in the normal-eGFR group. After adjusting for variables with P <0.10 in the univariable analysis, 6-month mortality was independently associated with high eGFR (hazard ratio, 2.22 [95% CI, 1.36–3.62]; P =0.001) and low eGFR (HR, 2.29 [95% CI, 1.41–3.72]; P =0.001). These associations persisted regardless of treatment modality or various baseline characteristics. CONCLUSIONS: High eGFR as well as low eGFR were independently associated with 6-month mortality after reperfusion therapy. Kidney function could be considered a prognostic factor in patients with ischemic stroke after reperfusion therapy.

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“…Data from the Nationwide Inpatient Sample 2002–2009 revealed higher in-hospital mortality in dialysis-dependent patients than in non-dialysis patients treated with IV thrombolytics (22% vs 11%, P<0.0001) 23. In the modern EVT era, a meta-analysis showed that RD is associated with less functional independence (OR 0.59, 95% CI 0.45 to 0.77) and a higher mortality (OR 2.23, 95% CI 1.45 to 3.43) 24. The post hoc analysis of the DIRECT-MT trial revealed that patients with non-RD had a lower 90-day mRS than RD patients (common aOR 0.26, 95% CI 0.15 to 0.45) 25.…”

Section: Discussionmentioning

confidence: 99%

Outcome of endovascular thrombectomy in patients with end-stage renal disease undergoing dialysis

Chen

Lin

et al. 2022

J NeuroIntervent Surg

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BackgroundPatients with end-stage renal disease (ESRD) are often excluded from clinical trials of endovascular thrombectomy (EVT). This study investigated the outcome in these patients.MethodsFrom September 2014 to July 2021, all patients undergoing EVT for anterior circulation stroke in two stroke centers in Taiwan were included. They were divided into no renal dysfunction (non-RD, estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2), RD (eGFR <60 mL/min/1.73 m2but no dialysis), and ESRD undergoing dialysis (ESRD-dialysis). The clinical features and outcomes were compared.ResultsOf 482 patients included, there were 20 ESRD-dialysis, 110 RD, and 352 non-RD patients. The Alberta Stroke Program Early CT Score (ASPECTS), National Institutes of Health Stroke Scale (NIHSS), use of intravenous thrombolysis, EVT-related time metrics, and successful recanalization rates were comparable among the three groups. However, the ESRD-dialysis patients had more symptomatic intracerebral hemorrhage (ICH, 15% vs 3.6% vs 3.7%), more contrast-induced encephalopathy (15% vs 1.8% vs 0.9%), and a higher mortality at 90 days (35% vs 18% vs 11%) than the other groups. Multivariable analysis revealed that ESRD-dialysis was associated with a less favorable outcome (OR 0.21, 95% CI 0.04 to 0.77) and more severe disability or mortality (modified Rankin Scale 5 or 6; OR 13.1, 95% CI 3.93 to 48.1) at 90 days. In the ESRD-dialysis group, the patients with premorbid functional dependence had a significantly higher mortality than those without (75% vs 8.3%; P=0.004).ConclusionESRD-dialysis patients were associated with symptomatic ICH and less favorable outcome at 90 days. Patients with premorbid functional dependency had an excessively high mortality.

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Impact of renal impairment on short-term outcomes following endovascular thrombectomy for acute ischemic stroke: A systematic review and meta-analysis

Cited by 8 publications

References 45 publications

Renal impairment and the prognosis of endovascular thrombectomy: a meta-analysis and systematic review

Renal impairment and the prognosis of endovascular thrombectomy: a meta-analysis and systematic review

Impact of Renal Function on Short-Term Outcome After Reperfusion Therapy in Patients With Ischemic Stroke

Outcome of endovascular thrombectomy in patients with end-stage renal disease undergoing dialysis

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