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Ischemic stroke
Original research
Outcome of endovascular thrombectomy in patients with end-stage renal disease undergoing dialysis
  1. Kuo-Wei Chen1,
  2. Chih-Hao Chen2,
  3. Yen-Heng Lin3,
  4. Chung-Wei Lee3,
  5. Kun-Chang Tsai4,
  6. Li-Kai Tsai4,
  7. Sung-Chun Tang5,
  8. Jiann-Shing Jeng5
  1. 1 Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
  2. 2 Taipei, National Taiwan University Hospital, Taipei, Taiwan
  3. 3 Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
  4. 4 Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
  5. 5 Neurology, National Taiwan University Hospital, Taipei, Taiwan
  1. Correspondence to Dr Chih-Hao Chen, Taipei, National Taiwan University Hospital, Taipei, Taiwan; antonyneuro{at}gmail.com

Abstract

Background Patients with end-stage renal disease (ESRD) are often excluded from clinical trials of endovascular thrombectomy (EVT). This study investigated the outcome in these patients.

Methods From September 2014 to July 2021, all patients undergoing EVT for anterior circulation stroke in two stroke centers in Taiwan were included. They were divided into no renal dysfunction (non-RD, estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2), RD (eGFR <60 mL/min/1.73 m2 but no dialysis), and ESRD undergoing dialysis (ESRD-dialysis). The clinical features and outcomes were compared.

Results Of 482 patients included, there were 20 ESRD-dialysis, 110 RD, and 352 non-RD patients. The Alberta Stroke Program Early CT Score (ASPECTS), National Institutes of Health Stroke Scale (NIHSS), use of intravenous thrombolysis, EVT-related time metrics, and successful recanalization rates were comparable among the three groups. However, the ESRD-dialysis patients had more symptomatic intracerebral hemorrhage (ICH, 15% vs 3.6% vs 3.7%), more contrast-induced encephalopathy (15% vs 1.8% vs 0.9%), and a higher mortality at 90 days (35% vs 18% vs 11%) than the other groups. Multivariable analysis revealed that ESRD-dialysis was associated with a less favorable outcome (OR 0.21, 95% CI 0.04 to 0.77) and more severe disability or mortality (modified Rankin Scale 5 or 6; OR 13.1, 95% CI 3.93 to 48.1) at 90 days. In the ESRD-dialysis group, the patients with premorbid functional dependence had a significantly higher mortality than those without (75% vs 8.3%; P=0.004).

Conclusion ESRD-dialysis patients were associated with symptomatic ICH and less favorable outcome at 90 days. Patients with premorbid functional dependency had an excessively high mortality.

  • Stroke
  • Thrombectomy

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author CH Chen.

https://doi.org/10.1136/jnis-2022-019666

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    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author CH Chen.

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    Footnotes

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    • Contributors K-WC prepared and revised the manuscript, designed the study, and performed the statistical analysis. C-HC provided critical idea, provided opinions on the statistical analysis, helped to revise the manuscript, and acted as guarantor. Y-HL, C-WL, K-CT and K-WC participated in the procedure of thrombectomy. Y-HL, C-WL, L-KT, J-SJ, and S-CT provided critical ideas of study design.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • 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.