Renal Dysfunction as a Risk Factor for Hemorrhagic Transformation and Poor Reperfusion After Mechanical Thrombectomy

Background: Mechanical thrombectomy (MT) is a cornerstone treatment for acute ischemic stroke (AIS) caused by large vessel occlusion. However, the effect of chronic kidney disease (CKD) on post-thrombectomy outcomes, particularly symptomatic hemorrhagic transformation (SHT), remains unclear.Methods: This retrospective cohort study included 208 patients with anterior circulation AIS who underwent MT between January 2019 and April 2023. CKD was diagnosed according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The primary endpoint was the development of SHT after endovascular therapy (EVT). Secondary outcomes included in-hospital mortality, 3-month mortality, and 3-month functional outcome measured by the modified Rankin Scale (mRS). Multivariate logistic regression was used to identify independent predictors of outcomes.Results: Of the 208 patients, 42 (20.2%) had CKD and 166 (79.8%) did not. The mean age was 68.4 ± 14.7 years, and the mean baseline NIHSS score was 14.8 ± 4.8. SHT occurred in 38 patients (18.3%). CKD was independently associated with an increased risk of SHT (Odds Ratio [OR] = 3.08, 95% Confidence Interval [CI]: 1.14–8.32, p  = 0.027), poor reperfusion (mTICI 0–2a) (OR = 0.45, 95% CI: 0.20–0.99, p  = 0.047), in-hospital mortality (OR = 3.87, 95% CI: 1.53–9.81, p  = 0.004), and 3-month mortality (OR = 2.57, 95% CI: 1.03–6.43, p  = 0.044).Conclusion: CKD is an independent predictor of SHT and early mortality after MT in AIS patients. These findings highlight the importance of close hemodynamic and metabolic monitoring in patients with impaired renal function undergoing endovascular stroke therapy.