Renal function and post-thrombectomy outcomes and safety: nationwide registry study

Abstract

Background: The impact of renal function on patients receiving endovascular thrombectomy (EVT) remains uncertain due to inconsistent results from previous studies. We investigated the effects of estimated glomerular filtration rate (eGFR) at admission on outcomes.

Methods: This cohort study analyzed data from the Taiwan Registry of EVT for Acute Ischemic Stroke (2019-24). Patients were categorized based on admission eGFR (mL/min/1.73 m²): renal hyperfiltration (≥120), normal renal function (60-119), mild renal impairment (30-59), moderate renal impairment (15-29), and end stage renal disease (ESRD <15).

Results: Among 2561 patients, the distribution was: 3.2% renal hyperfiltration, 69.6% normal renal function, 24.1% mild/moderate renal impairment, and 3.1% ESRD. Functional independence at 90 days declined with worsening renal function (43.2% to 11.3%), while mortality increased (18.5% to 43.8%). After multivariable adjustment, both renal hyperfiltration (adjusted OR (aOR) 0.35; 95% CI 0.18 to 0.67) and ESRD (aOR 0.35; 95% CI 0.15 to 0.78) were independently associated with reduced 90 day functional independence. Renal impairment was associated with increased 90 day mortality. The beneficial effect of successful recanalization on survival diminished in patients with renal impairment. Post-EVT intracerebral hemorrhage risk remained similar across all eGFR groups. These results were consistent across predefined subgroups.

Conclusions: Both renal hyperfiltration and impairment predicted worse outcomes after EVT, but did not increase the risk of hemorrhage. The results indicate that EVT remains appropriate for all eligible patients, regardless of renal function.

Keywords: Hemorrhage; Stroke; Thrombectomy.