TY - JOUR
T1 - Outcomes with General Anesthesia Compared to Conscious Sedation for Endovascular Treatment of Medium Vessel Occlusions
T2 - Results of an International Multicentric Study
AU - MAD-MT Consortium
AU - Radu, Răzvan Alexandru
AU - Costalat, Vincent
AU - Romoli, Michele
AU - Musmar, Basel
AU - Siegler, James E.
AU - Ghozy, Sherief
AU - Khalife, Jane
AU - Salim, Hamza
AU - Shaikh, Hamza
AU - Adeeb, Nimer
AU - Cuellar-Saenz, Hugo H.
AU - Thomas, Ajith J.
AU - Kadirvel, Ramanathan
AU - Abdalkader, Mohamad
AU - Klein, Piers
AU - Nguyen, Thanh N.
AU - Heit, Jeremy J.
AU - Regenhardt, Robert W.
AU - Bernstock, Joshua D.
AU - Patel, Aman B.
AU - Rabinov, James D.
AU - Stapleton, Christopher J.
AU - Cancelliere, Nicole M.
AU - Marotta, Thomas R.
AU - Mendes Pereira, Vitor
AU - El Naamani, Kareem
AU - Amllay, Abdelaziz
AU - Tjoumakaris, Stavropoula I.
AU - Jabbour, Pascal
AU - Meyer, Lukas
AU - Fiehler, Jens
AU - Faizy, Tobias D.
AU - Guerreiro, Helena
AU - Dusart, Anne
AU - Bellante, Flavio
AU - Forestier, Géraud
AU - Rouchaud, Aymeric
AU - Mounayer, Charbel
AU - Kühn, Anna Luisa
AU - Puri, Ajit S.
AU - Dyzmann, Christian
AU - Kan, Peter T.
AU - Colasurdo, Marco
AU - Marnat, Gaultier
AU - Berge, Jérôme
AU - Barreau, Xavier
AU - Sibon, Igor
AU - Nedelcu, Simona
AU - Henninger, Nils
AU - Ota, Takahiro
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2024.
PY - 2024
Y1 - 2024
N2 - 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.
AB - 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.
KW - Anesthesia
KW - MeVO
KW - Outcomes research
KW - Reperfusion
KW - Stroke
KW - Thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85191811842&partnerID=8YFLogxK
U2 - 10.1007/s00062-024-01415-1
DO - 10.1007/s00062-024-01415-1
M3 - Article
AN - SCOPUS:85191811842
SN - 1869-1439
JO - Clinical Neuroradiology
JF - Clinical Neuroradiology
ER -