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Ischemic stroke
Original research
Influence of renal impairment on clinical outcomes after endovascular recanalization in vertebrobasilar artery occlusions
  1. Lulu Xiao1,
  2. Mengmeng Gu2,
  3. Yijiu Lu3,
  4. Pengfei Xu4,
  5. Jinjing Wang1,
  6. Wenya Lan5,
  7. Yong Huang6,
  8. Guoqiang Xu7,
  9. Shuanggen Zhu8,
  10. Qizhang Wang9,
  11. Wei Hu4,
  12. Wusheng Zhu1,
  13. Wen Sun4,
  14. Xinfeng Liu1,4
  1. 1 Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
  2. 2 Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
  3. 3 Department of Neurology, The First People’s Hospital of Yulin, Yulin, Guangxi, China
  4. 4 Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC,Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
  5. 5 Department of Cerebrovascular Disease Treatment Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
  6. 6 Department of Neurosurgery, Jiangsu Provincial Corps Hospital of Chinese People's Armed Police Forces, Yangzhou, China
  7. 7 Department of Neurology, The First People's Hospital of Yongkang, Yongkang, China
  8. 8 Department of Neurology, Affiliated to Longhua People's Hospital, Southern Medical University, Shenzhen, China
  9. 9 Department of Neurology, Shenzhen Shajing People's Hospital, Shenzhen, China
  1. Correspondence to Professor Xinfeng Liu, Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China; xfliu2{at}vip.163.com; Dr Wen Sun, Stroke Center & Department of Neurology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China; sunwen_medneuro{at}163.com

Abstract

Background Renal impairment (RI) is associated with worse outcomes in the treatment of intravenous thrombolysis and emergent endovascular treatment (EVT) in anterior circulation stroke. The objective of this study was to investigate the association of RI with short-term and long-term outcomes in patients with vertebrobasilar artery occlusions (VBAO) who received EVT.

Methods Consecutive patients with VBAO receiving EVT involving 21 stroke centers were retrospectively included. Multivariate regression analyses were used to evaluate the association of RI with mortality and symptomatic intracranial hemorrhage (sICH) during the hospital stay, and also mortality, favorable functional outcome (modified Rankin Scale (mRS) score of 0–3), and functional improvement (shift in mRS score) at 3 months and 1 year follow-up. The association between RI and the risk of recurrent stroke was evaluated with multivariate competing-risk regression analyses.

Results After adjustment for potential confounders, RI was independently associated with sICH (OR 3.30, 95% CI 1.55 to 7.18), as well as mortality (OR 2.54, 95% CI 1.47 to 4.38; OR 3.07, 95% CI 1.72 to 8.08), favorable functional outcome (OR 0.33, 95% CI 0.17 to 0.66; OR 0.25, 95% CI 0.12 to 0.51), and functional improvement (OR 0.45, 95% CI 0.28 to 0.74; OR 0.35, 95% CI 0.21 to 0.60) at 3 months and 1 year follow-up, respectively, but RI was not associated with in-hospital mortality. Additionally, there was no significant association between RI and recurrent stroke within 1 year.

Conclusions Our findings suggest that RI is associated with a higher risk of sICH in hospital and a decrease in survival, favorable functional outcome, and functional improvement at 90 days and 1 year follow-up.

Trial registration number URL: http://www.chictr.org.cn/; Unique identifier: ChiCTR2000033211.

  • intervention
  • stroke
  • thrombectomy

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/neurintsurg-2021-018003

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • LX and MG contributed equally.

    • Contributors LX, MG, XL, WS contributed to the study concept and design. YL, PX, WL, YH, GX, SZ, QW, JW contributed to acquisition and analysis of data. WH, WZ contributed to image review and drafting figures of the manuscript. LX, WS contributed to drafting the text. WS is responsible for the overall content as guarantor.

    • Funding This study was supported in part by National Science Foundation of China (81870946, 81701184, 81701229, 82001260), the Fundamental Research Funds for the Central Universities and National Key Research and Development Program of China (2017YFC1307901), the Key Research and Development Plan Projects of Anhui Province (202104j07020049). The funding organization had no role in the study.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.