Acute ischemic stroke & emergency mechanical thrombectomy: The effect of type of anesthesia on early outcome

• Published in: Clinical neurology and neurosurgery Vol. 202; p. 106494
• Main Authors: Byrappa, Vinay, Lamperti, Massimo, Ruzhyla, Aliaksandr, Killian, Aislinn, John, Seby, St Lee, Terrence
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-03-2021; Elsevier Limited
• Subjects: Acute ischemic stroke (AIS); Adult; Aged; Anesthesia; Anesthesia, General - methods; Blood pressure; Cardiovascular disease; Cardiovascular system; Coma; Conscious Sedation - methods; Emergency mechanical thrombectomy (EMT); Female; Functional Status; General anaesthesia (GA); General anesthesia; Glasgow Coma Scale; Hospital Mortality; Humans; Hypotension; Ischemia; Ischemic Stroke - physiopathology; Ischemic Stroke - surgery; Male; Medical personnel; Middle Aged; Modified rankin score (mRS); Mortality; Neurology; Patients; Procedural sedation (PS); Propofol; Remifentanil; Retrospective Studies; Statistical analysis; Stroke; Thrombectomy - methods; Time-to-Treatment - statistics & numerical data; Treatment Outcome; Variables; Abu Dhabi United Arab Emirates; United Arab Emirates; NIHSS; SBP; EVT; OR; PS; REX; RASS; Emergency mechanical thrombectomy (EMT); AIS; EMR; Acute ischemic stroke (AIS); Procedural sedation (PS); Modified rankin score (mRS); mRS; DBP; General anaesthesia (GA); GA; TCI; MAP; ED
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2021.106494

•There is lack of consensus on the impact of anesthesia modality on outcome of patients undergoing mechanical thrombectomy (EMT).•Use of general anesthesia (GA) did not significantly delay the time to groin puncture or the time to recanalization.•The requirement of vasopressors to maintain target mean arterial pressure (MAP) was significantly higher in GA group.•There is no difference between GA and Procedural sedation (PS) on functional outcome at discharge and mortality.
Endovascular mechanical thrombectomy (EMT) is the standard of care for acute ischemic stroke (AIS) caused by proximal large vessel occlusions. There is conflicting evidence on outcome of patients undergoing EMT under procedural sedation (PS) or general anesthesia (GA). In this retrospective study we analyze the effect of GA and PS on the functional outcome of patients undergoing EMT.
Patients who have been admitted at our institute AIS and were treated with EMT under GA or PS between January 2015 and September 2018 were included in the study. Primary end point was the proportion of patients with good functional outcome as defined by a modified Rankin score (mRS) 0−2 at discharge.
A total of 155 patients were analyzed in this study including 45 (29.03 %) patients who received 97 GA, 110 (70.9 %) PS and 31 of these received Dexmedetomidine/Remifentanil. The median (IQR) 98 mRS at discharge was 4.0 (1.0–4.0) in the GA group Vs 3.00, (1.00−4.00) in the PS group. Among the secondary outcomes the lowest MAP recorded was significantly less in GA group (64.56 100 ± 18.70) compared to PS group (70.86 ± 16.30); p = 0.03. The PS group had a lower odd of mRS 3–5 (after adjustment), however, this finding was statistically not significant (OR 0.52 [0.07−3.5] 102 p = 0.5).
Our retrospective analysis did not find any influence of GA compared to PS whenever this was delivered by target controlled infusion (TCI) of propofol or by remifentanil/dexmedetomidine (REX) on early functional outcome.