Abstract TP163: Effect Of Renal Impairment On Clinical Outcomes Among Acute Ischemic Stroke Patients Treated With Endovascular Therapy- A Bi-center Study.

Abstract

Objective: To investigate the effect of renal impairment on clinical outcomes among acute ischemic stroke (AIS) patients treated with endovascular therapy (EVT). Methods: We performed a retrospective analysis from January to December 2020 involving AIS patients with CKD and premorbid modified Rankin Scale (mRS) ≤2, undergoing EVT in two large academic comprehensive stroke centers. Our primary efficacy outcome of interest was mRS at 90 days. Secondary outcomes included: inpatient mortality, length of hospitalization and reperfusion status based on Thrombolysis in Cerebral Infarction (TICI) score. CKD was defined as estimated glomerular filtration rate (eGFR) ranging from mild (eGFR 60-89 mL/min), moderate (eGFR 30-59 mL/min) or severe (eGFR 15-29 mL/min). We performed ordinal regression, multinomial logistic regression and binomial logistic regression analyses. In our subgroup analysis, we compared outcomes among AIS patients diagnosed with mild, moderate and severe CKD. We additionally performed a sensitivity analysis comparing patients with treated with combined intravenous thrombolysis (IVT) and EVT vs EVT only. Results: A total of 484 AIS patients underwent EVT at both stroke centers during the study period. After excluding patients for missing data and baseline mRS >2, total of 300 AIS patients who underwent EVT (176 CKD and 124 patients with normal renal function) were included. Patients with CKD was associated with worse clinical outcomes [4 (2-6) vs 3 (1-6)]; adjusted odds ratio [aOR] 1.70, 95% confidence interval [CI] 1.10 - 2.61, p =0.02] based on 90-day mRS shift analysis and increased odds of in-hospital mortality (aOR 2.63, 95% CI; 1.08-6.38, p =0.03). Rates of TICI 2b/3 reperfusion ( p =0.84) and length of stay ( p =0.42) were similar between the two groups. Subgroup analyses found no difference between CKD and normal renal function groups for primary and secondary outcomes (all p >0.05). Similarly, sensitivity analyses demonstrated no difference in clinical outcomes between patients receiving combined IVT and EVT compared to EVT only (all p >0.05). Conclusion: Among AIS patients undergoing EVT, renal impairment was independently associated with worsening functional outcomes at 90 days and a higher rate of inpatient mortality.