Influence of Renal Function on Treatment Results after Stroke Thrombectomy

Abstract

Background: Renal dysfunction (RD) may be associated with poor outcome in ischemic stroke patients treated with mechanical thrombectomy (MT), but data concerning this important and emerging comorbidity do not exist so far. Here, we investigated the influence of RD on postprocedural intracerebral hemorrhage (ICH), clinical outcome, and mortality in a large prospectively collected cohort of acute ischemic stroke patients treated with MT. Methods: Consecutive patients with anterior-circulation stroke treated with MT between October 2010 and January 2016 were included. RD was defined as glomerular filtration rate (GFR) <60 mL/min/1.73 m². In a prospective database, clinical characteristics were recorded and brain images were analyzed for the presence of ICH after treatment in all patients. Clinical outcome was assessed by the modified Rankin Scale (mRS) after 3 months. To evaluate associations between clinical factors and outcomes uni- and multivariate regression analyses were conducted. Results: In total, 505 patients fulfilled all inclusion criteria (female: 49.7%, mean age: 71.0 years). RD at admission was present in 20.2%. RD patients were older and had cardiovascular risk factors more often. Multivariate regression analysis after adjustment for age, stroke severity, diabetes, hypertension, GFR, previous stroke, MT alone, or additional thrombolysis and recanalization results revealed that lower GFR was not independently associated with poor outcome (mRS 3-6; OR 1.13, 95% CI 0.99-1.28; p = 0.072) or ICH. However, lower GFR at admission was associated with a higher risk of mortality (OR 1.15, 95% CI 1.01-1.31; p = 0.038). Compared to admission, GFR values were higher at discharge (mean: 77.9 vs. 80.8 mL/min/1.73 m²; p = 0.046). Conclusions: We did not find evidence for an association of lower GFR with an increased risk of poor outcome and ICH, but lower GFR was a determinant of 90-day mortality after endovascular stroke treatment. Our findings encourage also performing MT in this relevant subgroup of acute ischemic stroke patients.

Renal Impairment Is Associated with Intracerebral Hemorrhage after Mechanical Thrombectomy in Vertebrobasilar Stroke

“…Due to the lack of imaging data, we can only speculate that a higher rate of infratentorial cerebral microbleeds may be the cause of the observed association of RD with ICH in our cohort. While no association between RD and postprocedural ICH was observed in a former study of patients with anterior circulation stroke [5], further studies, evaluating a possible influence of cerebral microbleeds in these patients, would be desirable. Interestingly, we observed a strong trend toward an association between delayed groin puncture and ICH, which is in accordance to a previous study, reporting an association between symptomatic ICH and symptom-to-groin times that exceeded 270 min [21].…”

“…Moreover, due to limited numbers, a detailed statistical analysis on symptomatic and fatal ICHs was not reasonable, and our results remain descriptive. We cannot exclude that a selection bias may have contributed to differing results between anterior [5] and posterior circulation stroke patients and because of the observational character of our analysis, we did also not perform a prespecified power analysis. We can also not exclude that the overall restricted number of cases may have contributed to our results.…”

“…Moreover, evidence suggests that ischemic stroke in patients with RD is associated with a worse functional and clinical outcome [3,4]. On the other hand, in patients with acute anterior circulation strokes treated with mechanical thrombectomy, a recent study did not identify an association between RD and poor outcome or intracerebral hemorrhage (ICH) [5]. Of note, patients with RD are prone to have strokes in the posterior circulation [6], and RD is associated with higher frequencies of deep cerebral microbleeds [7,8].…”

Influence of renal function on stroke outcome after mechanical thrombectomy: a prospective cohort study

“…Several previous observational studies investigated the relationship between renal function and stroke outcomes. However, only one study included MT patients and their results were conflicting [4][5][6][7][8][17][18][19][20][21]. Some studies found that reduced eGFR significantly increased the risk of stroke mortality [4,5] and it was associated with poor outcome and sICH after intravenous thrombolysis [6].…”

“…These discrepancies may be explained by the following reasons. First, the stroke type, some studies included both ischemic and hemorrhagic stroke [5,7,18,19], while others were one type only [4,6,8,17,20,21]. Second, different onset time.…”