Shuangzhi Wang

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.

Objective: This study aimed to investigate the association between admission serum phosphate levels and clinical outcomes in patients with acute basilar artery occlusion undergoing endovascular treatment. Methods: This study was a subgroup analysis of the BASILAR registry. In total, 342 patients with acute basilar artery occlusion undergoing endovascular treatment whose admission serum phosphate levels were available were included. Participants were stratified into three groups according to tertiles of admission serum phosphate levels: (a) Tertile 1 (≤0.89 mmol/L); (b) Tertile 2 (0.90–1.09 mmol/L); and (c) Tertile 3 (>1.09 mmol/L). The primary outcome was a modified Rankin Scale score of 0–2 at 90 days. Safety outcomes included 90-day mortality and symptomatic intracranial hemorrhage within 48 h. Results: In total, 342 eligible patients were included and stratified into three groups based on serum phosphate level tertiles. Compared with Tertile 1, patients in Tertile 3 (adjusted odds ratio: 3.04, 95% confidence interval: 1.39–6.66, p = 0.006) and Tertile 2 (adjusted odds ratio: 2.61, 95% confidence interval: 1.21–5.66, p = 0.015) had significantly higher odds of achieving modified Rankin scale scores of 0–2 at 90 days. No significant differences were observed in mortality or symptomatic intracranial hemorrhage between the three groups. Restricted cubic spline analysis revealed a significant nonlinear, inverted U-shaped association between serum phosphate levels and modified Rankin scale scores of 0–2 ( p for nonlinearity = 0.016). Conclusions: Admission serum phosphate levels within the high-normal range were associated with favorable 90-day clinical outcomes in patients with acute basilar artery occlusion undergoing endovascular treatment, suggesting that serum phosphate level is as a prognostic biomarker in this population.