That makes me severely disinterested and skeptical about hygienic macros.
They are too weird for the little benefit they provide. You can't look at a piece of code and know what it expands to.
Hygienic macros break lexical scope, because code produced by a macro being invoked in some file "A.lisp" is seeing lexical variables defined in some different file "B.lisp". Lexical scope must be physically enclosed and contained. If you expand it here, it sees the variables that are here, and not some other ones elsewhere that you don't see here.
Given a nesting like (x (y (z a))), if y binds a, that must be like a brick wall; there is no way that the a reference in z can get around it, to connect with a binding of a produced by x. Either that a refers to z's own binding, or else to y. Yet hygienic macros can perpetrate a lexical-scope-destroying wormhole which can do that: the inner a reference can bypass a definition set up by y, and go to the one in x.
It's a downright security issue, like going around your company's firewall, or escaping a container or chroot jail or whatever.