Objective

To determine the influence of renal impairment on clinical outcomes in patients presenting emergent anterior circulation occlusion treated with mechanical thrombectomy.

Methods

Consecutive patients with anterior circulation stroke treated with mechanical thrombectomy at 41 academic tertiary care centers were included. renal impairment was defined as glomerular filtration rate <60 mL/min/1.73 m² at the time of admission. The primary outcome was the distribution of scores on the modified Rankin scale, and safety outcomes were mortality within 90 days and hemorrhagic complications. Binary and ordinal logistic regression was used to evaluate the associations between renal impairment and categorical outcomes. Linear regression was used to assess continuous outcomes.

Results

A total of 607 patients (47 renal impairment and 600 non-renal impairment) who underwent mechanical thrombectomy were included in this study. Multivariate regression analysis showed that renal impairment was independently associated with the increase of the modified Rankin scale at 90 days. The proportion of patients with successful reperfusion was 71.7% in the renal impairment group and 83.3% in the non-renal impairment group. Renal impairment was an independent predictor of 90-day mortality. No significant treatment for the ordinal modified Rankin scale or 90-day mortality was observed by renal impairment interaction. The risk of asymptomatic intracranial hemorrhage was higher in the mechanical thrombectomy plus IVT group (53.6%) than in the mechanical thrombectomy alone group (15.8%) for renal impairment, but was similar between the mechanical thrombectomy plus IVT group (34.6%) and the mechanical thrombectomy alone group (36.4%) for non-renal impairment (p = 0.01).

Conclusion

These results demonstrated that the outcomes of mechanical thrombectomy alone and mechanical thrombectomy plus IVT group did not differ significantly in acute stroke patients with and without renal impairment. Also, renal impairment was an independent predictor of worse functional independence and higher mortality at 90 days.

中文翻译：

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肾功能损害对动脉内治疗的有效性和安全性的影响：DIRECT-MT 研究的事后分析

客观的

确定肾功能损害对接受机械血栓切除术治疗的急诊前循环闭塞患者临床结局的影响。

方法

纳入了在 41 个学术三级医疗中心接受机械血栓切除术治疗的连续前循环卒中患者。肾功能损害定义为入院时肾小球滤过率<60 mL/min/1.73 m ²。主要结果是改良 Rankin 量表的评分分布，安全性结果是 90 天内的死亡率和出血并发症。二元和有序逻辑回归用于评估肾功能损害与分类结果之间的关联。线性回归用于评估连续结果。

结果

本研究共纳入 607 名接受机械血栓切除术的患者（47 名肾功能不全患者和 600 名非肾功能不全患者）。多变量回归分析表明，肾功能损害与 90 天时改良 Rankin 量表的增加独立相关。再灌注成功的患者比例在肾功能损害组为 71.7%，在非肾功能损害组为 83.3%。肾功能损害是 90 天死亡率的独立预测因子。肾功能损害相互作用未观察到序数改良 Rankin 量表或 90 天死亡率的显着治疗。机械血栓切除加 IVT 组无症状颅内出血的风险 (53.6%) 高于单纯机械血栓切除组 (15.8%)，因为肾功能损害，p  = 0.01）。

结论

这些结果表明，单独机械血栓切除术和机械血栓切除加 IVT 组的结果在伴有和不伴有肾功能损害的急性卒中患者中没有显着差异。此外，肾功能损害是功能独立性较差和 90 天死亡率较高的独立预测因子。