Influence of renal impairment on neurologic outcomes following mechanical thrombectomy in acute vertebrobasilar stroke

Rhim, Jong Kook; Park, Jeong Jin; Ahn, Jun Hyong; Kim, Heung Cheol; Na, Doyoung; Chai, Chung Liang; Jeon, Jin Pyeong

doi:10.1007/s00234-021-02838-0

Cited by 4 publications

(11 citation statements)

References 35 publications

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“…14,[16][17][18][21][22][23][24] The association of RI with an increased risk of 3-month mortality held also for adjusted data (six studies; OR, 1.84; 95% CI, 1.45-2.33; I 2 = 74%). 14,16,17,[22][23][24] The details are shown in Figure 3.…”

Section: Study Quality and Publication Biasmentioning

confidence: 79%

“…The risk of 3-month poor functional outcome in patients with RI was 2.13 times higher than that in patients without RI; the pooled OR was 2.13 (95% CI, 1.77–2.56; I 2 = 45%). Five studies 14 , 16 , 17 , 22 , 24 reported adjusted data on the association between RI and 3-month poor functional outcomes after EVT. The risk of 3-month poor functional outcome in patients with RI was higher than that in patients without RI; the pooled OR was 1.49 (95% CI, 1.17–1.90; I 2 = 58%).…”

Section: Resultsmentioning

confidence: 99%

“…Association between RI and outcomes 3-month poor functional outcome. In total, 10 studies [15][16][17][18][19][20][21][22][23][24] reported unadjusted data on the association between RI and 3-month poor functional outcomes after EVT. The risk of 3-month poor functional outcome in patients with RI was 2.13 times higher than that in patients without RI; the pooled OR was 2.13 (95% CI, 1.77-2.56; I 2 = 45%).…”

Section: Study Quality and Publication Biasmentioning

confidence: 99%

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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: Study Quality and Publication Biasmentioning

confidence: 79%

Section: Resultsmentioning

confidence: 99%

Section: Study Quality and Publication Biasmentioning

confidence: 99%

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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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“…The majority of the trials assessing BT investigate ACS subjects only or do not analyse the PCS subgroup separately [ 36 , 37 ]. A meta-analysis comparing BT to standard medical treatment specifically in PCS did reveal a significant increase in sICH, but not in 90-day mortality [ 38 ]. Unfortunately, standard medical treatment was defined as any antithrombotic treatment including antiplatelets, IVT or both, making results not exactly applicable to this discussion.…”

Section: Discussionmentioning

confidence: 99%

“…Other findings associated with the risk of poor outcomes were RF and PAD. RF is a well-known risk factor for a worse stroke prognosis after EVT and for any ICH in PCS [ 37 , 38 , 39 ]. As for PAD, we suggest that this factor was linked to an increased risk of poor outcomes because it is a marker of an unfavourable cardiovascular profile and is linked to increased mortality rates in general [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Basilar Artery Occlusion: What Can We Learn from the Results?

et al. 2022

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Background and Objectives: Current guidelines lack specific endovascular treatment (EVT) recommendations for posterior circulation stroke (PCS). The results of earlier studies are controversial. We aimed to compare early hospital outcomes of stroke caused by large-vessel occlusion (LVO) treated with EVT or bridging therapy (BT) in anterior circulation stroke (ACS) versus PCS (middle cerebral artery occlusion (MCAO) and basilar artery occlusion (BAO), and establish the risk factors for poor outcome. Materials and Methods: we analyzed the data of 279 subjects treated with EVT due to LVO-caused stroke in a comprehensive stroke centre in 2015–2021. The primary outcome was hospital mortality, secondary outcomes were National Institutes of Health Stroke Scale (NIHSS) after 24 h, early neurological deterioration, futile recanalization (FR), the ambulatory outcome at discharge, and complications. Results: BAO presented with higher baseline NIHSS scores (19 vs. 14, p < 0.001), and longer door-to-puncture time (93 vs. 82 min, p = 0.034), compared to MCAO. Hospital mortality and the percentage of FR were the same in BAO and almost two times higher than in MCAO (20.0% vs. 10.3%, p = 0.048), other outcomes did not differ. In BAO, unsuccessful recanalization was the only significant predictor of the lethal outcome, though there were trends for PAD and RF predicting lethal outcome. A trend for higher risk of symptomatic intracranial hemorrhage (sICH) was observed in the BAO group when BT was applied. Nevertheless, neither BT nor sICH predicted lethal outcomes in the BAO group. Conclusions: Compared to the modern gold standard of EVT in the ACS, early outcomes in BAO remain poor, there is a substantial amount of FR. Nevertheless, unsuccessful recanalization remains the strongest predictor of lethal outcomes. BT in PCS might pose a higher risk for sICH, but not the lethal outcome, although this finding requires further investigation in larger trials.

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Thrombectomy versus combined thrombolysis and thrombectomy in patients with large vessel occlusion and chronic kidney disease

Niu,

Chen,

et al. 2024

Heliyon

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Influence of renal impairment on neurologic outcomes following mechanical thrombectomy in acute vertebrobasilar stroke

Cited by 4 publications

References 35 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

Endovascular Treatment of Basilar Artery Occlusion: What Can We Learn from the Results?

Thrombectomy versus combined thrombolysis and thrombectomy in patients with large vessel occlusion and chronic kidney disease

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