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Research Article | DOI: https://doi.org/10.31579/2768-2757/198
1Department of Neurology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
2Department of Neurology, Annapurna Neurological Institute and Allied Sciences, Kathmandu, Nepal.
3Department of Pharmacy, Bharatpur Hospital, Bharatpur, Nepal.
4Department of Nephrology, Manmohan Memorial Medical College and Teaching Hospital, Kathmandu, Nepal.
5Department of Global Healthcare Management, York St. John university, London, United Kingdom.
6Department of Emergency, Civil Service Hospital, Kathmandu, Nepal.
7Department of Internal Medicine, Civil Service Hospital, Kathmandu, Nepal.
8Department of Anesthesiology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, P.R. China.
9Department of Emergency, Kathmandu Model Hospital Institute Of Health Sciences, Kathmandu, Nepal.
10Department of Surgery, Kathmandu Model Hospital Institute Of Health Sciences, Kathmandu, Nepal.
11Department of Internal Medicine, Chongqing Medical University, Chongqing, P.R. China.
12Department of Clinical Medicine, Chandrakot Basic Hospital, Gulmi Shantipur, Nepal.
13Department of Clinical Medicine, Tianjin Medical University, Tianjin, P.R. China.
*Corresponding Author: Ayush Chandra., Department of Clinical Medicine, Tianjin Medical University, Tianjin, P.R. China.
Citation: Chandra A., Acharya S., Sharma S., Dawadi S., Singh N, et al, (2026), Effect of Kidney Dysfunction on Disease Mechanisms and Outcomes in Acute Ischemic Stroke Managed with Endovascular Thrombectomy, Journal of Clinical Surgery and Research, 7(1); DOI:10.31579/2768-2757/198
Copyright: © 2026, Ayush Chandra. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 02 February 2026 | Accepted: 13 February 2026 | Published: 17 February 2026
Keywords: ischemic stroke; mechanical thrombectomy; renal dysfunction; acute kidney injury; prognosis the influence of renal dysfunction on pathophysiology and clinical outcomes in patients with acute ischemic stroke treated with endovascular thrombectomy
Background
Endovascular thrombectomy (EVT) has revolutionized the treatment of acute ischemic stroke (AIS), offering improved recanalization and functional outcomes. However, patient heterogeneity especially the presence of renal dysfunction remains a critical determinant of EVT success. Renal impairment is common in stroke populations and may negatively affect short-term post-procedural outcomes, yet it remains under-investigated in EVT-specific protocols.
Objective
This review aims to synthesize current evidence on the pathophysiological, clinical, and procedural implications of renal dysfunction in patients undergoing EVT for AIS and to highlight management considerations and future research directions.
Methods and Scope
We provide an overview of renal dysfunction classifications (acute kidney injury and chronic kidney disease), their prevalence in stroke cohorts, and the shared vascular and inflammatory pathways that link renal impairment with adverse cerebrovascular outcomes. Emphasis is placed on periprocedural risks such as contrast-induced nephropathy and hemodynamic instability and their contribution to delayed recovery, increased in-hospital mortality, hemorrhagic transformation, and prolonged ICU stays. We summarize key clinical studies, including retrospective analyses and available meta-analyses.
Results
Renal dysfunction is consistently associated with poorer neurological outcomes and increased post-EVT complications. Mechanisms include altered drug metabolism, systemic inflammation, and endothelial dysfunction.
Conclusion
Renal dysfunction should be recognized as a vital component in EVT risk stratification. Integrated, multidisciplinary management and personalized care approaches are essential. Future directions include the use of renal biomarkers, AI-driven predictive modeling, and renal-specific EVT protocols to optimize outcomes for this high-risk subgroup.
Acute ischemic stroke (AIS) remains one of the most devastating neurological emergencies worldwide, characterized by the sudden loss of cerebral blood flow due to arterial occlusion. It accounts for approximately 85% of all stroke cases and is a leading cause of disability and death globally [1]. The burden is especially profound in low- and middle-income countries, where timely access to specialized stroke care is often limited. In recent years, endovascular thrombectomy (EVT) has revolutionized the treatment landscape for AIS, particularly in patients with large vessel occlusion (LVO). Following the success of pivotal trials such as MR CLEAN, ESCAPE, and REVASCAT, EVT has been firmly established as a standard of care in eligible patients, offering significantly improvement in functional outcomes compared to best medical therapy alone [2–4]. These interventions, when performed within defined time windows, have shown remarkable efficacy in achieving recanalization and improvement in neurological recovery. Despite these advancements, not all patients benefit equally from EVT. Growing attention is now being directed toward understanding how pre-existing comorbidities influence the efficacy and safety of this intervention. Among various systemic factors, conditions such as hypertension, diabetes mellitus, atrial fibrillation, and renal dysfunction are emerging as key determinants of post-thrombectomy outcomes [5]. The complexity of managing stroke in patients with multiple comorbidities necessitates a more nuanced and individualized approach to EVT. Renal dysfunction, in particular, has gathered increasing interest in this context. Both acute kidney injury (AKI) and chronic kidney disease (CKD) are prevalent in AIS populations and have been independently associated with worse clinical outcomes, including increased mortality rates, hemorrhagic transformation, and prolonged hospitalization [6, 7]. The bidirectional pathophysiological relationship between cerebrovascular and renal systems often referred to as the "brain-kidney axis" adds another layer of complexity to the management of these patients [8]. This review aims to explore the impact of renal dysfunction on short-term outcomes after EVT in AIS. By examining current literature, underlying mechanisms, and clinical implications, we hope to provide clinicians and researchers with a deeper understanding of how renal impairment may alter the course and prognosis of EVT-treated stroke patients. We also highlight existing knowledge gaps and propose future directions for research and practice in this evolving field.
2.1 Definitions and Classifications
Renal dysfunction represents a spectrum of disorders affecting the kidneys’ ability to filter blood, regulate fluid and electrolyte balance, and eliminate waste products. Among these, acute kidney injury (AKI) and chronic kidney disease (CKD) are the most clinically significant and commonly encountered in both general and neurologic populations. AKI is characterized by a rapid decline in kidney function occurring over hours to days. It is often triggered by hemodynamic instability, nephrotoxic agents, or systemic insults such as sepsis. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines define AKI based on a rise in serum creatinine ⋝0.3 mg/dL within 48 hours, or a 1.5-fold increase from baseline within 7 days, or urine output <0.5 mL/kg/h for six hours [9]. In the context of AIS, the use of contrast-enhanced procedures like endovascular thrombectomy (EVT) increases the risk of AKI. In contrast, CKD refers to long-standing kidney damage or reduced kidney function that persists for more than three months. It is classified based on estimated glomerular filtration rate (eGFR) and the presence of kidney damage indicators such as proteinuria. According to KDIGO staging, CKD is divided into five stages: Stage 1 (eGFR ⋝90 mL/min/1.73 m² with evidence of kidney damage), through to Stage 5 (eGFR <15 mL/min/1.73 m²), which signifies end-stage renal disease (ESRD) (Table 1) [10]. Patients with advanced CKD often exhibit vascular, inflammatory, and metabolic disturbances that may influence cerebrovascular outcomes. The eGFR remains the most widely used clinical tool for estimating renal function. It is derived from serum creatinine using equations such as CKD-EPI or MDRD, accounting for variables like age, sex, and race. While convenient, eGFR has limitations in acute settings, especially when renal function is fluctuating or serum creatinine is not in steady state [11].
| Stage | eGFR (mL/min/1.73 m²) | Description |
| 1 | ⋝90 | Normal or high GFR with kidney damage |
| 2 | 60–89 | Mildly decreased GFR |
| 3a | 45–59 | Mild to moderate decrease |
| 3b | 30–44 | Moderate to severe decrease |
| 4 | 15–29 | Severe decrease |
| 5 | <15 | Kidney failure (end-stage renal disease) |
Table 1: KDIGO Classification of Chronic Kidney Disease (CKD).
Source: KDIGO 2012 Clinical Practice Guidelines [10]
2.2 Prevalence of Renal Dysfunction in Stroke Patients
Renal dysfunction is frequently observed in patients presenting with AIS. Studies estimate that up to 30–40% of stroke patients have some degree of CKD, with higher rates observed in those with large vessel atherosclerosis or cardioembolic sources [12, 13]. In addition to CKD, acute kidney injury (AKI) is also a common complication, occurring in approximately 13–36% of AIS patients, particularly in those undergoing procedures involving contrast exposure or with underlying risk factors like diabetes or heart failure [14] Even mild reductions in renal function have been independently associated with worse stroke outcomes, including increased mortality and poor functional recovery. Several factors contribute to this overlap between stroke and renal impairment. Both conditions share common vascular risk factors, including hypertension, diabetes mellitus, dyslipidemia, and smoking [15]. These shared etiologies create a synergistic burden on the cerebral and renal vasculature, predisposing individuals to arterial stiffness, endothelial dysfunction, and accelerated atherosclerosis. Additionally, systemic inflammation, oxidative stress, and prothrombotic states are heightened in both diseases, further amplifying the risk of adverse outcomes [16]. Importantly, renal dysfunction not only predisposes to stroke but also complicates its management. Patients with impaired renal function are at increased risk of contrast-induced nephropathy during imaging or interventional procedures, and they may be less tolerant of medications commonly used in stroke management, such as anticoagulants and antiplatelets [17]. This necessitates careful monitoring and a multidisciplinary approach to optimize care in this high-risk group.
The intricate relationship between the kidneys and the brain goes beyond shared vascular risk factors it is underpinned by complex pathophysiological mechanisms that interconnect renal dysfunction with cerebrovascular injury. Understanding these mechanisms is essential, especially in the context of AIS, as renal impairment can amplify brain damage and influence recovery. The “brain–kidney axis” illustrates this multidirectional interaction through several overlapping pathways.
3.1 Endothelial Dysfunction
One of the earliest and most significant contributors to both renal and cerebral vascular disease is endothelial dysfunction. In chronic kidney disease (CKD), there is a marked reduction in the bioavailability of nitric oxide (NO), a key vasodilator, alongside elevated levels of endothelin-1, a potent vasoconstrictor [18]. These changes compromise vascular tone and promote thrombogenesis [18]. The cerebral endothelium, responsible for regulating blood flow to neuronal tissue, becomes similarly impaired in patients with renal dysfunction, increasing the risk of ischemic events [19]. Moreover, uremic toxins such as asymmetric dimethylarginine (ADMA) further inhibit NO synthesis and damage vascular integrity [20].
3.2 Inflammation and Oxidative Stress
Chronic systemic inflammation and oxidative stress are hallmarks of both CKD and AKI. Elevated levels of pro-inflammatory cytokines such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) are frequently observed in patients with renal impairment and have been directly linked to stroke severity and poor neurological outcomes [21]. These inflammatory mediators disrupt endothelial function, attract leukocytes, and promote thrombosis. Furthermore, oxidative stress contributes to lipid peroxidation and DNA damage in cerebral cells, exacerbating the ischemic injury [22]. This inflammatory cascade is not only a trigger for stroke but also a driver of secondary brain injury post-stroke.
3.3 Impaired Cerebral Autoregulation
Cerebral autoregulation refers to the brain's ability to maintain consistent cerebral blood flow despite fluctuations in systemic blood pressure. In patients with renal dysfunction, this autoregulatory mechanism is often compromised. Studies have shown that CKD patients exhibit blunted cerebrovascular reactivity and increased cerebral pulsatility, both of which predispose to hypoperfusion or hyperperfusion during acute ischemic events [23]. Autoregulatory failure may contribute to increased infarct size and limited protective capacity of collateral circulation, especially during interventions like EVT.
3.4 Atherosclerosis and Microangiopathy
Renal and cerebrovascular disease are shared consequences of atherosclerosis In CKD, there is an accelerated form of vascular calcification and arterial stiffness, even in younger individuals, leading to early-onset large vessel disease [24]. At the same time, microangiopathy damage to small cerebral vessels is prevalent, particularly in advanced CKD and diabetic nephropathy. This microvascular injury results in white matter changes, lacunar infarctions, and cerebral small vessel disease, all of which are associated with poorer functional recovery after stroke [25]. These vascular pathologies not only increase the risk of initial stroke but also worsen prognosis after reperfusion therapy.
3.5 Effects on Blood–Brain Barrier Integrity
The blood–brain barrier (BBB) is a specialized structure that regulates the movement of substances between the blood and the central nervous system. Renal dysfunction impairs BBB integrity through multiple mechanisms, including uremic toxin accumulation, oxidative damage, and systemic inflammation [26]. Disruption of the BBB allows crossing of inflammatory cells and neurotoxic molecules into brain tissue, contributing to cerebral edema and hemorrhagic transformation after ischemic events. This is particularly concerning in EVT candidates, where BBB compromise may increase the risk of post-procedural complications such as symptomatic intracerebral hemorrhage [27].
4.1 Periprocedural Risks
Patients with renal dysfunction face several periprocedural complications during EVT for AIS. One prominent concern is contrast-induced nephropathy (CIN), a form of AKI triggered by iodinated contrast agents used during imaging and EVT. Although the incidence of CIN in general stroke populations is relatively low, patients with pre-existingCKD), diabetes mellitus, or dehydration are at significantly higher risk [17]. Studies have shown that CIN can occur in up to 10–15% of stroke patients with baseline eGFR <60 mL/min/1.73 m², potentially worsening kidney function and prolonging hospitalization [28]. Another important consideration is hemodynamic instability, particularly in those with advanced renal disease. CKD and ESRD are often associated with impaired autonomic function and volume dysregulation, which can lead to hypotension during anesthesia or procedural stress [29]. Such instability can compromise cerebral perfusion during EVT, increasing infarct volume and negatively affecting neurological outcomes. Moreover, delayed recovery is commonly observed in patients with renal dysfunction undergoing EVT. This may be partly attributable to systemic inflammation, metabolic derangements, and reduced physiological reserve. These patients are also more likely to have complications such as infection or fluid overload post-procedure, which may delay neurological rehabilitation and extend intensive care needs [30].
4.2 Impact on Short-Term Outcomes
Renal dysfunction has a tangible effect on short-term functional outcomes after EVT. Neurological scoring systems such as the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) consistently show worse outcomes in patients with impaired kidney function. For instance, reduced eGFR levels were significantly associated with worse functional outcomes after stroke. Specifically, patients with CKD had a 1.54-fold higher risk of poor outcome (mRS >2) at 3 months (adjusted OR: 1.54; 95% CI: 1.33–1.79; p < 0.001) compared to those with normal renal function. Additionally, lower eGFR was associated with higher NIHSS scores at discharge, indicating more severe neurological deficits [25]. In-hospital mortality is also significantly higher among EVT-treated stroke patients with CKD.. In a large multicenter cohort study, patients with CKD had a significantly higher in-hospital mortality rate (10.4%) compared to those with normal renal function (5.8%; P < 0.001). After adjusting for age, stroke severity, and comorbidities, CKD remained an independent predictor of mortality (adjusted odds ratio 1.82; 95% CI, 1.33–2.50; P < 0.001) [31]. This trend is particularly pronounced in patients requiring dialysis, who have limited physiologic reserve and higher baseline cardiovascular risk. Renal dysfunction also appears to increase the risk of hemorrhagic transformation, a feared complication of reperfusion therapy. Endothelial fragility, altered coagulation profiles, and uremic platelet dysfunction may contribute to this heightened risk. In a retrospective cohort analysis, advanced CKD was linked with an increased incidence of both symptomatic and asymptomatic intracranial hemorrhage post-EVT [32]. Finally, renal impairment often correlates with prolonged ICU and hospital stays. This is due not only to the direct effects of kidney dysfunction but also to the increased burden of medical management, including dialysis, fluid/electrolyte monitoring, and complication management. Patients with CKD frequently require extended rehabilitation services and are more likely to be discharged to skilled nursing facilities rather than home [33].
4.3 Evidence from Clinical Studies
A growing body of clinical research supports the association between renal dysfunction and poor outcomes post-EVT. Patients with eGFR <60>
The interaction between renal dysfunction and clinical outcomes after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) is complex and multifactorial. Several underlying mechanisms have been proposed that may explain why patients with impaired renal function are more likely to experience complications and suboptimal recovery after EVT (Table 2).
5.1 Altered Pharmacokinetics of Drugs
Renal dysfunction significantly affects the pharmacokinetics and pharmacodynamics of commonly used medications in stroke management, including sedatives, antihypertensives, anticoagulants, and antiplatelets. Reduced glomerular filtration impairs drug clearance, leading to drug accumulation and toxicity, or alternatively, subtherapeutic effects due to altered protein binding or metabolism [38]. For example, renally cleared anticoagulants like low molecular weight heparin or direct oral anticoagulants may accumulate in CKD patients, increasing the risk of bleeding during or after EVT [39]. In contrast, drugs such as clopidogrel may be less effective in uremic patients due to impaired platelet function and altered drug metabolism, potentially increasing the risk of re-occlusion or stent thrombosis [40]. Careful dose adjustment and monitoring are essential in this group, but emergency EVT scenarios often lack the luxury of time, thereby compounding risk.
| Mechanism | Description |
| Altered pharmacokinetics | Drug accumulation or reduced efficacy due to impaired renal clearance |
| Systemic inflammation | Elevated cytokines (e.g., IL-6, CRP) worsen neurovascular injury |
| Coagulation abnormalities | Uremia-induced platelet dysfunction; bleeding and thrombotic risks |
| Impaired vascular healing | Endothelial dysfunction and impaired endothelial progenitor cell (EPC) repair |
| Immunosuppression | Higher risk of post-stroke infections (e.g., pneumonia, UTI, sepsis) |
Table 2: Mechanisms Linking Renal Dysfunction to Poor EVT Outcomes.
Sources: [20, 42-47]
5.2 Increased Systemic Inflammation
Chronic kidney disease is known to be a pro-inflammatory state, marked by elevated levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), even in the absence of acute infection [20]. This systemic inflammation accelerates vascular injury, promotes plaque instability, and compromises neurovascular repair following EVT. Inflammatory cytokines can impair collateral circulation, reduce neuroplasticity, and enhance BBB permeability, making reperfusion more harmful than beneficial in some cases [41]. These factors together may explain why renal dysfunction is independently associated with worse neurological recovery and higher rates of hemorrhagic transformation after EVT.
5.3 Coagulation Abnormalities
Patients with renal dysfunction, particularly those in advanced stages or on dialysis, often display coagulation abnormalities. Uremia impairs platelet aggregation and function, leading to a paradoxical state of both bleeding and thrombosis [42]. Altered levels of fibrinogen, D-dimer, and von Willebrand factor are commonly observed, making periprocedural management of EVT complex and risky. In the context of AIS and EVT, this imbalance may increase the risk of intracranial hemorrhage post-recanalization or impair control of thrombus formation, thus impacting recanalization success and recovery [43]. Furthermore, the use of intravenous thrombolysis prior to EVT in patients with renal dysfunction adds another layer of bleeding risk.
5.4 Impaired Vascular Healing
Effective vascular healing after EVT is essential for maintaining vessel patency, reducing re-occlusion risk, and preventing complications such as dissection or aneurysm formation. However, in CKD patients, endothelial dysfunction and a pro-oxidative environment hinder vascular repair mechanisms [44]. Uremic toxins like indoxyl sulfate and p-cresyl sulfate have been shown to directly impair endothelial progenitor cell (EPC) function, which is crucial for endothelial regeneration following vascular injury [45]. As a result, the damaged cerebral vasculature in renal patients may not heal effectively post-thrombectomy, increasing the risk of complications such as intracranial hemorrhage and delayed neurological recovery.
5.5 Immunosuppression and Infection Risk
Finally, immunosuppression in CKD is a well-established phenomenon, often described as “uremic immunodeficiency.” These patients exhibit impaired leukocyte function, reduced chemotaxis, and decreased phagocytic activity, predisposing them to a higher incidence of nosocomial infections, including pneumonia, urinary tract infections, and bloodstream infections following EVT [46]. Infections are a major contributor to early neurological deterioration and prolonged hospitalization in stroke patients, especially those in intensive care units (ICUs). Moreover, the systemic inflammatory response triggered by infections may exacerbate cerebral edema, increase infarct size, and diminish the benefits of successful recanalization [47].
The intersection of renal dysfunction and AIS management particularly in the setting of EVT demands careful clinical decision-making. Since patients with impaired renal function face both heightened procedural risks and worse short-term outcomes, individualized strategies must be employed to optimize safety and therapeutic benefit.
6.1 Patient Selection for EVT
Evaluating renal function pre-procedure is essential when considering EVT. Baseline renal assessment, particularly the estimated glomerular filtration rate (eGFR), helps identify patients at increased risk of contrast-induced nephropathy, bleeding, and poor neurological outcomes. According to the KDIGO guidelines, an eGFR <60>
6.2 Periprocedural Management
Hydration strategies are the cornerstone of renal protection in interventional procedures. Isotonic saline administered prior to and after EVT can help reduce the risk of CIN, especially in patients with pre-existing CKD. The use of sodium bicarbonate and N-acetylcysteine has been explored, though data remain mixed [49]. Minimizing contrast use is another key strategy. Many modern thrombectomy techniques allow successful recanalization with limited or even no contrast if roadmaps and non-contrast CT imaging are optimally used. Moreover, the adoption of low-osmolar or iso-osmolar contrast agents has been shown to reduce nephrotoxicity in at-risk patients [50].
Monitoring and managing AKI is crucial in the hours to days following EVT. Serial serum creatinine, urine output monitoring, and biomarkers like neutrophil gelatinase-associated lipocalin (NGAL) can provide early warning signs of renal deterioration [51]. If AKI develops, timely nephrology consultation and supportive measures such as fluid balance correction, electrolyte management, and avoidance of nephrotoxic drugs can prevent progression to severe renal failure.
6.3 Post-EVT Monitoring and Care
Following EVT, renal support remains a critical aspect of comprehensive post-stroke care, especially in patients with pre-existing CKD or perioperative AKI. This includes careful fluid management, judicious use of diuretics, and renal dose adjustment of commonly used medications like antibiotics, anticoagulants, and sedatives [52]. A multidisciplinary stroke care model that includes nephrologists, neurologists, critical care physicians, and rehabilitation specialists improves outcomes for this vulnerable subgroup. Studies have demonstrated that integrated stroke units with renal consultation services lead to earlier detection of complications and more precise intervention planning [53]. Lastly, early identification of clinical deterioration neurologic or renal is essential. Tools like the mRS and the NIHSS should be complemented with renal surveillance indicators. Deterioration may manifest subtly through worsening cognitive status, electrolyte imbalances, or fluid overload. Timely action can prevent secondary insults that may compromise recovery.
Despite increasing awareness of the intersection between renal dysfunction and outcomes after endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), significant gaps persist in our current understanding. These limitations span definitional inconsistencies, trial design shortcomings, and lack of focused protocols hindering the development of evidence-based strategies for this high-risk population.
7.1 Heterogeneity in Definitions of Renal Dysfunction
One of the most prominent challenges is the lack of standardized definitions for renal dysfunction across stroke studies. Terms such as CKD, AKI, and reduced eGFR are often used interchangeably or with varying thresholds. Some studies define CKD using an eGFR cutoff of <60>
7.2 Lack of Renal-Specific EVT Protocols
Although EVT has become a gold-standard intervention for large vessel occlusion strokes, renal-specific considerations are often absent from standard protocols. Unlike contrast-based procedures in cardiology or nephrology where preventive strategies for AKI are routine, neurointerventional guidelines rarely include specific precautions for patients with reduced renal reserve [56]. There is limited consensus on optimal hydration regimens, contrast agent choice, or thresholds for withholding EVT in patients with severe renal dysfunction. Most EVT guidelines such as those from the American Heart Association/American Stroke Association focuses on neurological and imaging criteria, without integrating renal parameters into decision-making algorithms [57]. This gap highlights the need for protocols that consider the delicate renal-neurologic interplay.
7.3 Underrepresentation in Trials
Another major shortcoming is the underrepresentation of patients with renal dysfunction in major EVT trials. Landmark studies like MR CLEAN, EXTEND-IA, and DAWN excluded or poorly reported data on individuals with CKD or elevated creatinine levels [2, 58,59]. Consequently, the external validity of these trials to real-world populations where renal dysfunction is common, especially among older patients is questionable. This underrepresentation is often due to concerns over contrast toxicity, bleeding risk, or poor prognosis, leading to exclusion either explicitly or implicitly during recruitment. As a result, clinicians are left to extrapolate findings from healthier cohorts, which may not accurately reflect outcomes in patients with significant renal comorbidity.
7.4 Need for Prospective Studies
While retrospective studies and subgroup analyses have begun to shed light on the impact of renal impairment in EVT-treated patients, well-designed prospective studies are urgently needed. These should focus on both safety and efficacy outcomes, stratified by renal function categories, and include predefined renal endpoints such as AKI incidence, contrast nephropathy, and renal-related morbidity. Furthermore, randomized controlled trials (RCTs) incorporating renal-protective strategies like low-contrast protocols, hydration interventions, or contrast-free imaging could provide evidence for tailored management in this subgroup. Until such data is available, clinical practice must rely on limited observational evidence and extrapolation from other disciplines.
The complex interplay between renal dysfunction and EVT outcomes in AIS patients underscores the pressing need for more personalized and integrative approaches in stroke care. While current evidence provides valuable insights, several promising avenues are emerging that could transform how we assess, manage, and predict outcomes in patients with renal impairment undergoing EVT.
8.1 Personalized EVT Strategies
One of the most compelling directions for the future is the personalization of EVT strategies. Current treatment algorithms are largely standardized and do not sufficiently account for the nuanced risks associated with comorbid renal dysfunction. A more individualized approach factoring in renal function, hemodynamic stability, contrast load capacity, and patient frailty could better balance procedural benefit and systemic risk. This paradigm shift is supported by emerging evidence in broader stroke care, where tailored interventions based on patient phenotypes have shown potential in improving outcomes [60]. Studies suggest that personalized EVT protocols may include using alternative imaging (e.g., non-contrast MR angiography), ultra-low contrast strategies, and selective use of adjunctive therapies like antiplatelets or anticoagulants based on renal and bleeding risk profiles [61].
8.2 Integration of Renal Biomarkers in Stroke Care
Another promising area is the integration of renal biomarkers into routine stroke management. Traditional markers such as serum creatinine and eGFR may not provide an early or sensitive indication of acute renal injury in EVT candidates. Biomarkers like neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, and kidney injury molecule-1 (KIM-1) have shown potential in the early detection of subclinical AKI and predicting renal outcomes after contrast exposure [51,62]. Incorporating these markers into pre-procedural risk stratification tools could help clinicians identify high-risk individuals earlier and implement renal-protective strategies proactively. Furthermore, longitudinal biomarker tracking might offer a dynamic measure of renal status during the post-EVT recovery phase.
8.3 AI and Predictive Modeling in EVT Outcomes
The application of artificial intelligence (AI) and predictive modeling in stroke care is growing rapidly, and renal dysfunction could become a key variable in these models. Machine learning algorithms that synthesize clinical data, imaging features, and lab values (including renal indices) are being developed to predict EVT success, hemorrhagic transformation, and functional recovery [63]. In one recent study, an AI model incorporating renal function data alongside perfusion metrics and procedural parameters demonstrated improved accuracy in predicting 90-day functional outcomes compared to traditional logistic regression models [64]. Such tools can aid in refining patient selection, guiding real-time intraoperative decisions, and informing discussions with patients and families about prognosis.
8.4 Clinical Trials Focusing on Renal Dysfunction in Stroke
To date, few prospective trials have specifically focused on patients with renal dysfunction undergoing EVT, representing a significant knowledge gap. Most large stroke trials have either excluded this population or failed to analyze renal status as a stratifying variable. There is a pressing need for dedicated randomized controlled trials that evaluate EVT safety, efficacy, and optimal management strategies in individuals with CKD or AKI. Future studies could explore modified EVT protocols for CKD patients, such as contrast-sparing techniques, hydration optimization, or the use of renal-protective pharmacologic agents. Equally important are observational registries that capture real-world data on EVT outcomes in renal-impaired populations across different ethnicities, healthcare systems, and resource settings [65].
Renal dysfunction has emerged as a significant yet often underappreciated factor influencing the outcomes of EVT in AIS patients. Across multiple studies, reduced renal function whether chronic or acute has consistently been linked to poorer short-term neurological outcomes, increased rates of hemorrhagic transformation, prolonged hospital stays, and elevated in-hospital mortality. These associations are not merely coincidental but rooted in shared vascular pathologies, systemic inflammation, coagulation disturbances, and altered pharmacokinetics that jointly shape the procedural risk and recovery trajectory of stroke patients. Given the multifaceted impact of impaired renal function, a one-size-fits-all approach to EVT is no longer sufficient. The future of stroke care must be rooted in individualized treatment strategies, where renal parameters are not just noted but actively incorporated into patient selection, procedural planning, and post-EVT care. Such personalization could mean adjusting contrast dosages, implementing preemptive renal-protective measures, or even reconsidering EVT in patients with severe renal compromise unless clearly indicated. Equally vital is the call for an integrated renal-neurovascular management model, bringing together stroke neurologists, interventionalists, nephrologists, and critical care specialists to collaboratively guide decision-making. This multidisciplinary coordination is particularly important in the periprocedural and post-procedural phases, where fluctuations in renal function can have cascading effects on cerebral perfusion, recovery, and survival. Ultimately, improving outcomes for this vulnerable population will depend not only on refining EVT techniques but also on redefining how we understand and manage comorbidities like renal dysfunction in the broader context of cerebrovascular disease. Through further research, dedicated trials, and the adoption of evidence-based, renal-aware protocols, we can move closer to delivering safer, more equitable, and more effective care to all stroke patients.
Consent for publication
All participants and coauthors provided consent for the publication of the data and the required information.
Funding
This study has received no funding or any other type of monetary support.
Clinical Trial Number: Not Applicable
Consent to Publish declaration: Not Applicable
Consent to Participate declaration: Not Applicable
Ethics declaration: Not Applicable
Data Availability declaration: Not Applicable
All the authors contributed to this study and approved the final manuscript. A.V.C., M.F., and A.Y.C. conceived the study concept and design. A.Y.C., S.A., and S.S. drafted the initial manuscript. S.D., N.S., P.D., S.K.Y., P.G., P.R.S., and R.K.Y. contributed to data collection and literature review. W.E. and A.V.C. provided critical revisions and expert input on neurointerventional perspectives. S.D. contributed to nephrology-related content and interpretation. All authors contributed to manuscript editing, reviewed the final version critically for important intellectual content, and approved the submitted manuscript.
Declarations of competing interest
The authors declare that they have no conflicts of interest.
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Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Grace Pierce, International Journal of Clinical Case Reports and Reviews I appreciate the opportunity to review for Auctore Journal, as the overall editorial process was smooth, transparent and professionally managed. This journal maintains high scientific standards and ensures timely communications with authors, which is truly commendable. I would like to express my special thanks to editor Grace Pierce for his constant guidance, promt responses, and supportive coordination throughout the review process. I am also greatful to Eleanor Bailey from the finance department for her clear communication and efficient handling of all administrative matters. Overall, my experience with Auctore Journal has been highly positive and rewarding. Best regards, Sabita sinha
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
