This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
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.
Glossary
- ACTUAL=
- Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke Registry;
- AF=
- atrial fibrillation;
- aICH=
- asymptomatic intracranial hemorrhage;
- AIS=
- acute ischemic stroke;
- ASPECTS=
- Alberta Stroke Program Early CT Score;
- CI=
- confidence interval;
- cSVD=
- cerebral small vessel disease;
- eGFR=
- estimated glomerular filtration rate;
- ELVO=
- emergent large vessel occlusion;
- EVT=
- endovascular treatment;
- ICH=
- intracranial hemorrhage;
- IQR=
- interquartile range;
- IVT=
- IV thrombolysis;
- mRS=
- modified Rankin Scale;
- MT=
- mechanical thrombectomy;
- mTICI=
- modified Thrombolysis in Cerebral Infarction;
- NIHSS=
- NIH Stroke Scale;
- OR=
- odds ratio;
- PRM=
- propensity score–matched;
- RI=
- renal impairment;
- sICH=
- symptomatic intracranial hemorrhage
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
ACTUAL Investigators are listed at http://links.lww.com/WNL/B44.
- Received May 6, 2019.
- Accepted in final form July 31, 2019.
- © 2019 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Disputes & Debates: Rapid online correspondence
REQUIREMENTS
If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.