Renal Insufficiency and Clinical Outcomes in Acute Ischemic Stroke With Large Infarct: A Prospective Cohort Analysis

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Abstract
Background: This study aimed to investigate whether renal insufficiency (RI) modifies the effectiveness and safety of endovascular treatment (EVT) in patients with acute ischemic stroke and large infarct in a real‐world setting. Methods: This study was a post hoc analysis of a prospective multicenter cohort study. RI was defined as an estimated glomerular filtration rate 2 on admission. Patients were treated with EVT plus standard medical treatment or standard medical treatment alone and were stratified by RI status. The primary effectiveness outcome was favorable outcome (modified Rankin scale 0–3) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage and 90‐day mortality. Results: Among 745 patients with acute ischemic stroke and large infarct, 343 (46.0%) had RI and 490 (65.8%) underwent EVT. Compared with standard medical treatment, EVT was associated with improved functional outcomes (modified Rankin scale 0–3) in both the RI (adjusted odds ratio [OR] 2.55 [95% CI, 1.15–5.68], P =0.022) and the non‐RI group (adjusted OR 2.65 [95% CI, 1.49–4.73], P =0.001). EVT was also associated with higher risks of symptomatic intracranial hemorrhage in both groups ( P =0.002 and 0.007, respectively), whereas no significant difference in mortality was observed. Results were consistent in the inverse probability‐weighted analyses. No statistically significant interaction was observed between RI status and treatment effect for effectiveness or safety outcomes. Conclusions: In patients with acute ischemic stroke and large infarct, EVT was associated with improved functional outcomes but a higher risk of hemorrhagic complications. We did not find statistically significant evidence of interaction between EVT and RI status for 90‐day outcomes.

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