Renal function and post-thrombectomy outcomes and safety: nationwide registry study

Area of Science:

• Neurology
• Nephrology
• Interventional Cardiology

Background:

• The prognostic impact of renal function on patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke is not well-established.
• Previous studies have yielded inconsistent findings regarding the relationship between estimated glomerular filtration rate (eGFR) and EVT outcomes.

Purpose of the Study:

• To investigate the effect of admission eGFR on patient outcomes following EVT for acute ischemic stroke.
• To determine if renal function influences functional independence, mortality, and complication rates after EVT.

Main Methods:

• A cohort study utilizing data from the Taiwan Registry of EVT for Acute Ischemic Stroke (2019-2024).
• Patients were stratified into groups based on admission eGFR: renal hyperfiltration (≥120 mL/min/1.73 m²), normal (60-119), mild/moderate impairment (15-59), and end-stage renal disease (ESRD <15).
• Outcomes assessed included 90-day functional independence and mortality, with multivariable adjustments.

Main Results:

• Among 2561 patients, 3.2% had renal hyperfiltration, 69.6% normal function, 24.1% mild/moderate impairment, and 3.1% ESRD.
• Functional independence at 90 days decreased from 43.2% to 11.3% with worsening renal function, while mortality increased from 18.5% to 43.8%.
• Both renal hyperfiltration and ESRD were independently associated with reduced 90-day functional independence (aOR 0.35 for both). Renal impairment correlated with increased mortality, and the survival benefit of successful recanalization diminished in these patients. Intracerebral hemorrhage risk was similar across groups.

Conclusions:

• Both renal hyperfiltration and renal impairment are independent predictors of worse outcomes after EVT for acute ischemic stroke.
• Despite potential outcome differences, EVT is a suitable treatment option for all eligible patients, irrespective of their renal function status.
• Renal function does not appear to increase the risk of post-EVT intracerebral hemorrhage.