Lulu Xiao1, Minmin Ma1, Mengmeng Gu1, Yunfei Han1, Huaiming Wang1, Wenjie Zi1, Dong Yang1, Yonggang Hao1, Qiushi Lv1, Ruidong Ye1, Wen Sun2, Wusheng Zhu1, Gelin Xu1, Xinfeng Liu2. 1. From the Department of Neurology (L.X., M.M., Y. Han, H.W., D.Y., Q.L., R.Y., W. Zhu, G.X., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.G.), Nanjing First Hospital, Nanjing Medical University; Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang; Department of Neurology (W. Zi), Xinqiao Hospital, Third Military Medical University; Department of Neurology (Y. Hao), Sir Run Run Shaw Hospital, affiliated with the Zhejiang University School of Medicine, Hangzhou; and Stroke Center and Department of Neurology (W.S.), First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China. 2. From the Department of Neurology (L.X., M.M., Y. Han, H.W., D.Y., Q.L., R.Y., W. Zhu, G.X., X.L.), Jinling Hospital, Medical School of Nanjing University; Department of Neurology (M.G.), Nanjing First Hospital, Nanjing Medical University; Department of Neurology (H.W.), 89th Hospital of the People's Liberation Army, Weifang; Department of Neurology (W. Zi), Xinqiao Hospital, Third Military Medical University; Department of Neurology (Y. Hao), Sir Run Run Shaw Hospital, affiliated with the Zhejiang University School of Medicine, Hangzhou; and Stroke Center and Department of Neurology (W.S.), First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China. xfliu2@ustc.edu.cn sunwen_medneuro@163.com.
Abstract
OBJECTIVE: To determine the influence of renal impairment (RI) on clinical outcomes at 3 months and the risk of recurrent stroke in patients presenting with emergent large vessel occlusion (ELVO) treated with emergent endovascular treatment (EVT). METHODS: Consecutive patients with anterior circulation stroke due to ELVO treated with EVT in 21 endovascular centers were included. Multivariate regressions were used to evaluate the association of RI with mortality, functional independence (modified Rankin Scale [mRS] score 0-2), and functional improvement (shift in mRS score) at 3 months. The association between RI and the risk of recurrent stroke was evaluated with multivariate competing-risk regression analyses. RESULTS: A total of 628 patients with ELVO (mean age 64.7 ± 12.5 years, median NIH Stroke Scale score 17 points, 99 [15.8%] with RI) who underwent EVT were enrolled. After adjustment for other relevant variables, multivariate regression analysis indicated that RI was independently associated with functional independence (adjusted odds ratio 0.53, 95% confidence interval [CI] 0.29-0.96, p = 0.035) at 3 months but not with mortality or functional improvement. Multivariate competing-risk regression analysis showed that patients with RI who received EVT had a significantly higher risk of recurrent stroke (adjusted hazard ratio 2.56, 95% CI 1.27-5.18, p = 0.009) compared to those with normal renal function. CONCLUSION: Our results suggest that RI is an independent predictor of functional independence at 3 months and long-term risk of recurrent stroke in patients with ELVO treated with EVT.
OBJECTIVE: To determine the influence of renal impairment (RI) on clinical outcomes at 3 months and the risk of recurrent stroke in patients presenting with emergent large vessel occlusion (ELVO) treated with emergent endovascular treatment (EVT). METHODS: Consecutive patients with anterior circulation stroke due to ELVO treated with EVT in 21 endovascular centers were included. Multivariate regressions were used to evaluate the association of RI with mortality, functional independence (modified Rankin Scale [mRS] score 0-2), and functional improvement (shift in mRS score) at 3 months. The association between RI and the risk of recurrent stroke was evaluated with multivariate competing-risk regression analyses. RESULTS: A total of 628 patients with ELVO (mean age 64.7 ± 12.5 years, median NIH Stroke Scale score 17 points, 99 [15.8%] with RI) who underwent EVT were enrolled. After adjustment for other relevant variables, multivariate regression analysis indicated that RI was independently associated with functional independence (adjusted odds ratio 0.53, 95% confidence interval [CI] 0.29-0.96, p = 0.035) at 3 months but not with mortality or functional improvement. Multivariate competing-risk regression analysis showed that patients with RI who received EVT had a significantly higher risk of recurrent stroke (adjusted hazard ratio 2.56, 95% CI 1.27-5.18, p = 0.009) compared to those with normal renal function. CONCLUSION: Our results suggest that RI is an independent predictor of functional independence at 3 months and long-term risk of recurrent stroke in patients with ELVO treated with EVT.
Authors: Simon Fandler-Höfler; Balazs Odler; Markus Kneihsl; Gerit Wünsch; Melanie Haidegger; Birgit Poltrum; Markus Beitzke; Hannes Deutschmann; Christian Enzinger; Alexander R Rosenkranz; Thomas Gattringer Journal: Transl Stroke Res Date: 2021-01-04 Impact factor: 6.829