30.04.2024 | Original Article
Outcomes with General Anesthesia Compared to Conscious Sedation for Endovascular Treatment of Medium Vessel Occlusions: Results of an International Multicentric Study
verfasst von:
Răzvan Alexandru Radu, Vincent Costalat, Michele Romoli, Basel Musmar, James E. Siegler, Sherief Ghozy, Jane Khalife, Hamza Salim, Hamza Shaikh, Nimer Adeeb, Hugo H. Cuellar-Saenz, Ajith J. Thomas, Ramanathan Kadirvel, Mohamad Abdalkader, Piers Klein, Thanh N. Nguyen, Jeremy J. Heit, Robert W. Regenhardt, Joshua D. Bernstock, Aman B. Patel, James D. Rabinov, Christopher J. Stapleton, Nicole M. Cancelliere, Thomas R. Marotta, Vitor Mendes Pereira, Kareem El Naamani, Abdelaziz Amllay, Stavropoula I. Tjoumakaris, Pascal Jabbour, Lukas Meyer, Jens Fiehler, Tobias D. Faizy, Helena Guerreiro, Anne Dusart, Flavio Bellante, Géraud Forestier, Aymeric Rouchaud, Charbel Mounayer, Anna Luisa Kühn, Ajit S. Puri, Christian Dyzmann, Peter T. Kan, Marco Colasurdo, Gaultier Marnat, Jérôme Berge, Xavier Barreau, Igor Sibon, Simona Nedelcu, Nils Henninger, Takahiro Ota, Shogo Dofuku, Leonard L. L. Yeo, Benjamin YQ Tan, Anil Gopinathan, Juan Carlos Martinez-Gutierrez, Sergio Salazar-Marioni, Sunil Sheth, Leonardo Renieri, Carolina Capirossi, Ashkan Mowla, Lina M. Chervak, Achala Vagal, Priyank Khandelwal, Arundhati Biswas, Frédéric Clarençon, Mahmoud Elhorany, Kevin Premat, Iacopo Valente, Alessandro Pedicelli, Andrea M. Alexandre, João Pedro Filipe, Ricardo Varela, Miguel Quintero-Consuegra, Nestor R. Gonzalez, Markus A. YMD, Jessica Jesser, Charlotte Weyland, Adrien ter Schiphorst, Vivek Yedavalli, Pablo Harker, Yasmin Aziz, Benjamin Gory, Christian Paul Stracke, Constantin Hecker, Monika Killer-Oberpfalzer, Christoph J. Griessenauer, Cheng-Yang Hsieh, David S. Liebeskind, Illario Tancredi, Robert Fahed, Boris Lubicz, Muhammed Amir Essibayi, Amanda Baker, David Altschul, Luca Scarcia, Erwah Kalsoum, Adam A. Dmytriw, Adrien Guenego, MAD-MT Consortium
Erschienen in:
Clinical Neuroradiology
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Abstract
Background
Optimal anesthetic strategy for the endovascular treatment of stroke is still under debate. Despite scarce data concerning anesthetic management for medium and distal vessel occlusions (MeVOs) some centers empirically support a general anesthesia (GA) strategy in these patients.
Methods
We conducted an international retrospective study of MeVO cases. A propensity score matching algorithm was used to mitigate potential differences across patients undergoing GA and conscious sedation (CS). Comparisons in clinical and safety outcomes were performed between the two study groups GA and CS. The favourable outcome was defined as a modified Rankin Scale (mRS) 0–2 at 90 days. Safety outcomes were 90-days mortality and symptomatic intracranial hemorrhage (sICH). Predictors of a favourable outcome and sICH were evaluated with backward logistic regression.
Results
After propensity score matching 668 patients were included in the CS and 264 patients in the GA group. In the matched cohort, either strategy CS or GA resulted in similar rates of good functional outcomes (50.1% vs. 48.4%), and successful recanalization (89.4% vs. 90.2%). The GA group had higher rates of 90-day mortality (22.6% vs. 16.5%, p < 0.041) and sICH (4.2% vs. 0.9%, p = 0.001) compared to the CS group. Backward logistic regression did not identify GA vs CS as a predictor of good functional outcome (OR for GA vs CS = 0.95 (0.67–1.35)), but GA remained a significant predictor of sICH (OR = 5.32, 95% CI 1.92–14.72).
Conclusion
Anaesthetic strategy in MeVOs does not influence favorable outcomes or final successful recanalization rates, however, GA may be associated with an increased risk of sICH and mortality.