Renal Impairment Is Associated with Intracerebral Hemorrhage after Mechanical Thrombectomy in Vertebrobasilar Stroke

• Published in: Cerebrovascular diseases (Basel, Switzerland) Vol. 47; no. 1-2; p. 48
• Main Authors: Laible, Mona, Jenetzky, Ekkehart, Möhlenbruch, Markus A, Neuberger, Ulf, Bendszus, Martin, Ringleb, Peter A, Rizos, Timolaos
• Format: Journal Article
• Language: English
• Published: Switzerland 01.04.2019
• Subjects: Aged; Aged, 80 and over; Cerebral Hemorrhage - diagnostic imaging; Cerebral Hemorrhage - etiology; Databases, Factual; Female; Glomerular Filtration Rate; Humans; Kidney - physiopathology; Kidney Diseases - complications; Kidney Diseases - diagnosis; Kidney Diseases - physiopathology; Male; Middle Aged; Risk Assessment; Risk Factors; Stroke - complications; Stroke - diagnostic imaging; Stroke - surgery; Thrombectomy - adverse effects; Time Factors; Treatment Outcome; Vertebrobasilar Insufficiency - complications; Vertebrobasilar Insufficiency - diagnostic imaging; Vertebrobasilar Insufficiency - surgery; Posterior circulation; Mechanical thrombectomy; Mortality; Outcome; Intracerebral hemorrhage; Renal dysfunction
• ISSN: 1421-9786
• DOI: 10.1159/000497070

Renal dysfunction (RD) is overall associated with unfavorable functional outcome and higher risk of mortality after acute ischemic stroke. Associations between RD and outcome in patients with acute vertebrobasilar stroke treated with thrombectomy have not been evaluated so far. Consecutive patients with vertebrobasilar stroke treated with mechanical thrombectomy between October 2010 and July 2017 at our center were analyzed. RD was defined as glomerular filtration rate (GFR) < 60 mL/min/1.73 m2 at admission. Endpoints were (I) poor clinical outcome (modified Rankin Scale > 2) at 3 months, (II) 3-month mortality, and (III) intracerebral hemorrhage (ICH) after treatment. Overall, 106 patients were included. Median age was 73.0 years (interquartile range 62.0-80.0), and RD was present in 20.8%. Multivariate analysis revealed that RD was associated with a higher risk for any ICH (OR 3.54; 95% CI 1.09-11.49; p = 0.035). Stroke severity at onset predicted poor clinical outcome (OR 1.08; 95% CI 1.03-1.14; p = 0.003). Neither low GFR nor any ICH, but stroke severity (OR 1.08; 95% CI 1.03-1.14; p = 0.002) and poor recanalization results (OR 11.38; 95% CI 2.01-64.41; p = 0.006) were associated with a higher risk for mortality. Patients with RD and acute vertebrobasilar stroke should be thoroughly monitored to prevent ICH after thrombectomy. Our results support performing mechanical thrombectomy in acute stroke patients with large vessel occlusions of the posterior circulation, irrespective of their renal function.