#2648 IMPACT OF ACUTE AND CHRONIC KIDNEY FUNCTION ON THE SIZE AND PROGNOSIS OF ISCHEMIC STROKE AFTER THROMBECTOMY

Abstract

Abstract Background and Aims Patients with Chronic Kidney Disease (CKD) have an increased risk of ischemic and haemorrhagic stroke and CKD seem associated with worse outcome after a stroke. Few studies specifically investigated the impact of mechanical thrombectomy on outcomes after an ischemic stroke. The main objectives of our study RISOTTO were to evaluate the influence of CKD (eGFR < 60 mL/min/1.73m²) and Acute Kidney Injury (AKI) on the size of cerebral ischemic lesions and their outcome. Method Multicenter cohort study. Patients with at the acute phase of ischemic stroke following a large artery occlusion managed with mechanical thrombectomy were included. CKD was defined as eGFR < 60 mL/min/1.73m² for more than 3 months, AKI by 2012 KDIGO score, infarcted volume by ASPECTS and functional prognosis at 3 month by modified Rankin Scale (mRS). Results 296 patients were included. Sixty-three patients (22.8%) had CKD. In univariate analysis, patients with CKD had more white matter vascular lesions (Fazekas 1.7±0.8 vs. 1.0±0.8, p<0.0001), had lower initial infarcted volume (ASPECTS 7.6±1.7 vs. 6.7±1.8, p = 0.003), for equivalent severity (NIHSS: 9.2±7.0 vs. 10.1±7.7, p = 0.404), had more thrombectomy failure (12.7% vs. 3.8%, p = 0.008) compared to non-CKD patients. At 3 months, CKD was associated with equivalent functional prognosis (mRS 3–6: 51.6% vs. 42.2%, p = 0.193) but higher mortality: 24.2% vs. 9.5%, p = 0.004. Forty-eight patients (19.6%) developed an AKI. AKI was associated with increased initial gravity (NIHSS 18.8±5.2 vs. 16.7±5.7, p = 0.014, equivalent stroke volume (ASPECTS 7.3±1.9 vs. 6.8±1.8, p = 0.254. At 3 months, CKD was associated with poorer functional prognosis (mRS 3–6: 64.6% vs. 39.4%, p = 0,002) and mortality: 25.0% vs. 8.4%, p = 0.003. In multivariate analysis, AKI appeared as a independent risk factor of poor neurological outcome (OR 2.16 [1.05-4.46], p = 0,036 and mortality: OR 2.47 [0.96-6.35], p = 0.059 at 3 month, as CKD was not. Conclusion CKD was associated with smaller initial ischemic lesions for equivalent neurological severity, and more recanalization failures. CKD was not an independent risk factor for mortality or poor functional prognosis at 3 months. CKD patients seem to benefit from thrombectomy and should not be contraindicated to this technique. AKI is associated with greater initial neurological severity, poorer functional prognosis and increased mortality at 3 months and is an independent risk factor for poor prognosis.