TY - JOUR
T1 - General anesthesia vs procedural sedation for failed NeuroThrombectomy undergoing rescue stenting
T2 - Intention to treat analysis
AU - Mohammaden, Mahmoud H.
AU - Haussen, Diogo C.
AU - Al-Bayati, Alhamza R.
AU - Hassan, Ameer E.
AU - Tekle, Wondwossen
AU - Fifi, Johanna T.
AU - Matsoukas, Stavros
AU - Kuybu, Okkes
AU - Gross, Bradley A.
AU - Lang, Michael
AU - Narayanan, Sandra
AU - Cortez, Gustavo M.
AU - Hanel, Ricardo A.
AU - Aghaebrahim, Amin
AU - Sauvageau, Eric
AU - Farooqui, Mudassir
AU - Ortega-Gutierrez, Santiago
AU - Zevallos, Cynthia B.
AU - Galecio-Castillo, Milagros
AU - Sheth, Sunil A.
AU - Nahhas, Michael
AU - Salazar-Marioni, Sergio
AU - Nguyen, Thanh N.
AU - Abdalkader, Mohamad
AU - Klein, Piers
AU - Hafeez, Muhammad
AU - Kan, Peter
AU - Tanweer, Omar
AU - Khaldi, Ahmad
AU - Li, Hanzhou
AU - Jumaa, Mouhammad
AU - Zaidi, Syed F.
AU - Oliver, Marion
AU - Salem, Mohamed M.
AU - Burkhardt, Jan Karl
AU - Pukenas, Bryan
AU - Kumar, Rahul
AU - Lai, Michael
AU - Siegler, James E.
AU - Peng, Sophia
AU - Alaraj, Ali
AU - Nogueira, Raul G.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Background There is little data available to guide optimal anesthesia management during rescue intracranial angioplasty and stenting (ICAS) for failed mechanical thrombectomy (MT). We sought to compare the procedural safety and functional outcomes of patients undergoing rescue ICAS for failed MT under general anesthesia (GA) vs non-general anesthesia (non-GA). Methods We searched the data from the Stenting and Angioplasty In Neuro Thrombectomy (SAINT) study. In our review we included patients if they had anterior circulation large vessel occlusion strokes due to intracranial internal carotid artery (ICA) or middle cerebral artery (MCA-M1/M2) segments, failed MT, and underwent rescue ICAS. The cohort was divided into two groups: GA and non-GA. We used propensity score matching to balance the two groups. The primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included functional independence (90-day mRS0-2) and successful reperfusion defined as mTICI2B-3. Safety measures included symptomatic intracranial hemorrhage (sICH) and 90-day mortality. Results Among 253 patients who underwent rescue ICAS, 156 qualified for the matching analysis at a 1:1 ratio. Baseline demographic and clinical characteristics were balanced between both groups. Non-GA patients had comparable outcomes to GA patients both in terms of the overall degree of disability (mRS ordinal shift; adjusted common odds ratio 1.29, 95% CI [0.69 to 2.43], P=0.43) and rates of functional independence (33.3% vs 28.6%, adjusted odds ratio 1.32, 95% CI [0.51 to 3.41], P=0.56) at 90 days. Likewise, there were no significant differences in rates of successful reperfusion, sICH, procedural complications or 90-day mortality among both groups. Conclusions Non-GA seems to be a safe and effective anesthesia strategy for patients undergoing rescue ICAS after failed MT. Larger prospective studies are warranted for more concrete evidence.
AB - Background There is little data available to guide optimal anesthesia management during rescue intracranial angioplasty and stenting (ICAS) for failed mechanical thrombectomy (MT). We sought to compare the procedural safety and functional outcomes of patients undergoing rescue ICAS for failed MT under general anesthesia (GA) vs non-general anesthesia (non-GA). Methods We searched the data from the Stenting and Angioplasty In Neuro Thrombectomy (SAINT) study. In our review we included patients if they had anterior circulation large vessel occlusion strokes due to intracranial internal carotid artery (ICA) or middle cerebral artery (MCA-M1/M2) segments, failed MT, and underwent rescue ICAS. The cohort was divided into two groups: GA and non-GA. We used propensity score matching to balance the two groups. The primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included functional independence (90-day mRS0-2) and successful reperfusion defined as mTICI2B-3. Safety measures included symptomatic intracranial hemorrhage (sICH) and 90-day mortality. Results Among 253 patients who underwent rescue ICAS, 156 qualified for the matching analysis at a 1:1 ratio. Baseline demographic and clinical characteristics were balanced between both groups. Non-GA patients had comparable outcomes to GA patients both in terms of the overall degree of disability (mRS ordinal shift; adjusted common odds ratio 1.29, 95% CI [0.69 to 2.43], P=0.43) and rates of functional independence (33.3% vs 28.6%, adjusted odds ratio 1.32, 95% CI [0.51 to 3.41], P=0.56) at 90 days. Likewise, there were no significant differences in rates of successful reperfusion, sICH, procedural complications or 90-day mortality among both groups. Conclusions Non-GA seems to be a safe and effective anesthesia strategy for patients undergoing rescue ICAS after failed MT. Larger prospective studies are warranted for more concrete evidence.
KW - Angioplasty
KW - Stroke
KW - Thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85154619634&partnerID=8YFLogxK
U2 - 10.1136/jnis-2022-019376
DO - 10.1136/jnis-2022-019376
M3 - Article
C2 - 36597943
AN - SCOPUS:85154619634
SN - 1759-8478
VL - 15
SP - E240-E247
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
IS - e2
ER -