To determine whether renal function is independently associated with infarct growth rate (IGR) in anterior circulation large vessel occlusion (ACLVO) stroke.

The pathophysiology of fast to slow infarct growth in ACLVO stroke is incompletely defined. Renal function has been previously implicated in cerebral microangiopathy and clinical outcomes after stroke, but its relationship with IGR has not been previously investigated.  

Retrospective study of patients with acute intracranial ICA or MCA occlusion across two academic comprehensive stroke centers in 2014-2019. Patients were included if they received baseline MRI or CTP on presentation within 24 hours after stroke onset. IGR was calculated as ischemic core volume (ml) / time from stroke onset to imaging (h).  Baseline demographics, vascular co-morbidities, NIHSS, and basic laboratories including serum creatinine and blood urea nitrogen were recorded and tested in multivariable linear regression for association with IGR. 

A total of 237 patients were included, with mean age 71 (SD 69 – 73) and NIHSS median 17 (IQR 2-22). 58% were female, 73% hypertensive, 25% diabetic, and 43% had hyperlipidemia. Mean (SD) for IGR, serum creatinine and BUN were 12.8 (27.3) ml/h, 1.09 (0.97) mg/dL and 19.8 (9.5) mg/dL respectively. On multivariable analysis, only creatinine (3.64, 95% CI 0.26 - 7.02, P=0.035) and NIHSS (0.93, 95% CI 0.53 - 1.33, P<0.001) were independently associated with IGR. 

Serum creatinine was independently associated with IGR of ACLVO stroke, which may help predict fast or slow progressor status on acute patient presentation. Further studies are required to better understand the relationship between renal function and individual tolerance to ACLVO stroke.