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BACKGROUND This study aimed to investigate the incidence of contrast‐associated acute kidney injury (CA‐AKI) and renal replacement therapy (RRT) after endovascular therapy (EVT) for acute ischemic stroke. METHODS PubMed, the Cochrane Library, and the Web of Science were searched to identify all relevant studies regarding the incidence of CA‐AKI and RRT in patients with acute ischemic stroke receiving EVT until July 2021. To pool the incidence of CA‐AKI and RRT, a random‐effects model with a double arcsine transformation was used. Subgroup analysis and meta‐regression analysis were used to investigate the relationship of individual study‐level covariates with CA‐AKI and RRT. RESULTS It was found that 15 studies involving 27 246 patients with acute ischemic stroke receiving EVT met the inclusion criteria. The incidence of CA‐AKI was 5.0% (95% CI, 2.1%–8.9%), and the incidence of RRT was 0.2% (95% CI, 0.0%–0.4%). Subgroup analysis showed that the incidence of CA‐AKI was higher when using the European Society of Urogenital Radiology's criteria (6.6%, 95% CI, 3.8%–10.1%) than when using the Kidney Disease: The Improving Global Outcomes criteria (3.0%, 95% CI, 1.0%–6.1%). Meta‐regression analysis confirmed that the presence of diabetes was associated with increased rates of CA‐AKI ( P =0.002); however, the rates of CA‐AKI were not elevated because of impaired baseline estimated glomerular filtration rate ( P =0.518), chronic kidney disease ( P =0.860), or the volume of contrast ( P =0.536). CONCLUSIONS The risk of CA‐AKI and RRT secondary to EVT is low for patients with acute ischemic stroke; therefore, treatment should not be delayed for the patients eligible for EVT by waiting for the results of renal function analysis.

Introduction Acute cancer is associated with poorer prognosis and death in patients with acute ischemic stroke (AIS).1 Endovascular treatment has shown to be effective and safety treatment (EVT) for AIS with large vessel occlusion2; however, the effect of acute cancer on outcomes secondary to EVT in patients with AIS remains unclear. Methods We searched PubMed, Embase, as well as Cochrane for all relevant literature until June 1, 2022. Random‐effects model was used to estimate outcomes including good functional outcome, successful reperfusion, mortality at 3‐month, and symptomatic intracerebral hemorrhage. The heterogeneity of outcomes was assessed using the Cochran Q test and I2 statistics. Results Of the 12 studies, a total of 5,944 patients with AIS were enrolled. 389 (6.5%) patients had acute cancer. A quarter of patients regained functional independence after EVT. Compared with patients without acute cancer, those with acute cancer following EVT had similar rate of successful reperfusion (76.9% versus 72.6%; OR, 0.90; 95% CI, 0.63–1.30; I2 = 27%; p = 0.18; Figure 1A) and did not increase the risk of symptomatic intracerebral hemorrhage (6.0% versus 7.7%; OR, 0.85; 95% CI, 0.51–1.42; I2 = 0%; p = 0.45; Figure 1B). However, patients with acute cancer had more functional dependence (28.2% versus 42.3%; OR, 0.53; 95% CI, 0.41–0.67; I2 = 1%; p = 0.43; Figure 1C) and death at 3‐month (39.3% versus 18.6%; OR, 3.64; 95% CI, 2.35–6.27; I2 = 64%; p < 0.01; Figure 1D) than those without acute cancer. Conclusions The results of study showed that patients with acute cancer and AIS had a higher risk of functional dependence and mortality than those without acute cancer despite successful reperfusion and no increment in the occurrence of symptomatic intracerebral hemorrhage. Only 28.2% of patients with acute cancer regained functional independence, so physicians and patients should consider whether to use EVT for patients with acute cancer. There remained the need for further randomized control studies for better clinical evidence.