{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:37:33Z","timestamp":1793039853204,"version":"4.5.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Contrast-associated acute kidney injury (CA-AKI) after endovascular thrombectomy (EVT) worsens outcomes in acute ischemic stroke, but threshold-based definitions do not capture prognostic information from subthreshold changes. We tested whether early creatinine change within 48 hours of EVT conveys graded prognostic information beyond dichotomous CA-AKI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We performed a secondary analysis of the CAN-REST registry (Contrast-Associated Nephropathy After Endovascular Stroke Treatment), a retrospective multicenter observational cohort study of 6638 EVT-treated adults with acute ischemic stroke enrolled at 73 centers in 16 countries between January 1 and December 31, 2023. Early creatinine change was quantified as the natural logarithm ratio of 48-hour creatinine to baseline creatinine (ln[48-hour\/baseline creatinine]), with CA-AKI defined per Kidney Disease: Improving Global Outcomes criteria (\u22650.3 mg\/dL or \u22651.5\u00d7 baseline rise within 48 hours). Multivariable logistic regression adjusted for prespecified baseline and periprocedural covariates examined associations with 90-day modified Rankin Scale shift and in-hospital mortality; linear versus restricted cubic spline specification was selected by likelihood ratio testing, and contrasts were estimated at \u00b110%, \u00b125%, and \u00b150%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Greater creatinine worsening within 48 hours of EVT was independently associated with an unfavorable 90-day modified Rankin Scale shift (adjusted common odds ratio per 1-unit log-ratio increase, 1.48 [95% CI, 1.07\u20132.04]; linear) and in-hospital mortality (nonlinear dose-response, of larger magnitude). A 10% increase in creatinine at 48 hours\u2014well below Kidney Disease: Improving Global Outcomes threshold\u2014was associated with worse functional outcome (adjusted common odds ratio, 1.04 [95% CI, 1.01\u20131.07]) and death (adjusted odds ratio, 1.22 [95% CI, 1.13\u20131.32]); a 10% decrease in creatinine at 48 hours was associated with lower odds of both outcomes (adjusted common odds ratio, 0.96 [95% CI, 0.93\u20130.99]; adjusted odds ratio, 0.74 [95% CI, 0.65\u20130.86]). The functional-outcome association concentrated at upper modified Rankin Scale cut-points (severe disability, death); effect modification by baseline renal function was not significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Early creatinine change after EVT conveys graded, outcome-specific prognostic information extending below formal CA-AKI thresholds, with a dose-response detectable at changes as modest as \u00b110%, complementing binary CA-AKI as a framework for post-EVT renal risk assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT06596603.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.126.056847","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T09:00:58Z","timestamp":1790845258000},"page":"3292-3305","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the Threshold: Continuous Creatinine Change and Outcomes After Endovascular Thrombectomy for Acute Ischemic Stroke"],"prefix":"10.1161","volume":"57","clinical-trial-number":[{"clinical-trial-number":"nct06596603","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8465-3946","authenticated-orcid":true,"given":"Ghil","family":"Schwarz","sequence":"first","affiliation":[{"name":"Vascular Neurology and Stroke Unit (G. Schwarz, A.C.R., S.B., M.L.), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy."},{"name":"Department of Neurology and Stroke Unit (G. Schwarz, A.C.R., S.B., M. Sessa), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3258-5061","authenticated-orcid":true,"given":"Angelo","family":"Cascio Rizzo","sequence":"additional","affiliation":[{"name":"Vascular Neurology and Stroke Unit (G. Schwarz, A.C.R., S.B., M.L.), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy."},{"name":"Department of Neurology and Stroke Unit (G. Schwarz, A.C.R., S.B., M. Sessa), ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gareth","family":"Ambler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6114-2024","authenticated-orcid":true,"given":"Pawel","family":"Wrona","sequence":"additional","affiliation":[{"name":"Department of Neurology (P.W., A. Slowik), Jagiellonian University Medical College, Krakow, Poland."},{"name":"Student Scientific Group in Cerebrovascular Diseases, Faculty of Medicine (P.W., A. Slowik, A.B.), Jagiellonian University Medical College, Krakow, Poland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8261-537X","authenticated-orcid":true,"given":"Agnieszka","family":"Slowik","sequence":"additional","affiliation":[{"name":"Department of Neurology (P.W., A. Slowik), Jagiellonian University Medical College, Krakow, Poland."},{"name":"Student Scientific Group in Cerebrovascular Diseases, Faculty of Medicine (P.W., A. Slowik, A.B.), Jagiellonian University Medical College, Krakow, Poland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Bodzioch","sequence":"additional","affiliation":[{"name":"Student Scientific Group in Cerebrovascular Diseases, Faculty of Medicine (P.W., A. Slowik, A.B.), Jagiellonian University Medical College, Krakow, Poland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8279-5078","authenticated-orcid":true,"given":"Mohamed F.","family":"Doheim","sequence":"additional","affiliation":[{"name":"Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (M.F.D., A.R.A.-B., R.G.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8103-1930","authenticated-orcid":true,"given":"Alhamza R.","family":"Al-Bayati","sequence":"additional","affiliation":[{"name":"Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (M.F.D., A.R.A.-B., R.G.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4532-153X","authenticated-orcid":true,"given":"Raul G.","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, PA (M.F.D., A.R.A.-B., R.G.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5573-1551","authenticated-orcid":true,"given":"Ana Paiva","family":"Nunes","sequence":"additional","affiliation":[{"name":"Stroke Unit, Hospital de S\u00e3o Jos\u00e9, Unidade Local de Sa\u00fade de S\u00e3o Jos\u00e9, Lisboa, Portugal (A.P.N., P.F.)."},{"name":"Centro Cl\u00ednico Acad\u00e9mico de Lisboa, Portugal (A.P.N., P.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Stroke Unit, Hospital de S\u00e3o Jos\u00e9, Unidade Local de Sa\u00fade de S\u00e3o Jos\u00e9, Lisboa, Portugal (A.P.N., P.F.)."},{"name":"Centro Cl\u00ednico Acad\u00e9mico de Lisboa, Portugal (A.P.N., P.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5347-378X","authenticated-orcid":true,"given":"Matteo","family":"Paolucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1486-4507","authenticated-orcid":true,"given":"Andrea","family":"Zini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5238-4865","authenticated-orcid":true,"given":"Luigi","family":"Simonetti","sequence":"additional","affiliation":[{"name":"IRCCS Istituto delle Scienze Neurologiche di Bologna, Neuroradiology Unit, Maggiore Hospital, Italy (L. Simonetti)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0161-1685","authenticated-orcid":true,"given":"Norbert","family":"Le\u0161ko","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine (N.L., Z.G.), P.J. Safarik University and L. Pasteur University Hospital, Ko\u0161ice, Slovakia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6203-4854","authenticated-orcid":true,"given":"Jakub","family":"Fedorko","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine (J. Fedorko), P.J. Safarik University and L. Pasteur University Hospital, Ko\u0161ice, Slovakia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7396-5052","authenticated-orcid":true,"given":"Zuzana","family":"Gdovinov\u00e1","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine (N.L., Z.G.), P.J. Safarik University and L. Pasteur University Hospital, Ko\u0161ice, Slovakia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1316-0383","authenticated-orcid":true,"given":"Luca","family":"Scarcia","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, AP-HP, Henri Mondor University Hospital, DMU FIxIT, Cr\u00e9teil, France (L. 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