General Anesthesia Versus Conscious Sedation and Local Anesthesia During Thrombectomy for Acute Ischemic Stroke-Reference-Cited by-同舟云学术

General Anesthesia Versus Conscious Sedation and Local Anesthesia During Thrombectomy for Acute Ischemic Stroke

Published:2020-07 Issue:7 Volume:51 Page:2036-2044
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Cappellari Manuel¹^ORCID,Pracucci Giovanni²,Forlivesi Stefano¹,Saia Valentina³,Nappini Sergio⁴,Nencini Patrizia⁴,Inzitari Domenico²,Greco Laura⁵,Sallustio Fabrizio⁵,Vallone Stefano⁶,Bigliardi Guido⁶,Zini Andrea⁷,Pitrone Antonio⁸,Grillo Francesco⁸,Musolino Rosa⁸,Bracco Sandra⁹,Tinturini Rebecca⁹,Tassi Rossana⁹,Bergui Mauro¹⁰,Cerrato Paolo¹⁰,Saletti Andrea¹¹,De Vito Alessandro¹¹,Casetta Ilaria¹¹,Gasparotti Roberto¹²,Magoni Mauro¹²,Castellan Lucio¹³,Malfatto Laura¹³,Menozzi Roberto¹⁴,Scoditti Umberto¹⁴,Causin Francesco¹⁵,Baracchini Claudio¹⁵,Puglielli Edoardo¹⁶,Casalena Alfonsina¹⁶,Ruggiero Maria¹⁷,Malatesta Emanuele¹⁷,Comelli Chiara¹⁸,Chianale Gigliola¹⁸,Lauretti Dario Luca¹⁹,Mancuso Michelangelo¹⁹,Lafe Elvis²⁰,Cavallini Anna²¹,Cavasin Nicola²²,Critelli Adriana²²,Ciceri Elisa Francesca Maria¹,Bonetti Bruno¹,Chiumarulo Luigi²³,Petruzzelli Marco²³,Giorgianni Andrea²⁴,Versino Maurizio²⁴,Ganimede Maria Porzia²⁵,Tinelli Angelica²⁵,Auteri Wiliam²⁶,Petrone Alfredo²⁶,Guidetti Giulio²⁷,Nicolini Ettore²⁷,Allegretti Luca³,Tassinari Tiziana³,Filauri Pietro²⁸,Sacco Simona²⁸,Pavia Marco²⁹,Invernizzi Paolo²⁹,Nuzzi Nunzio Paolo³⁰,Carmela Spinelli Maria³⁰,Amistà Pietro³¹,Russo Monia³¹,Ferrandi Delfina³²,Corraine Simona³³,Craparo Giuseppe³⁴,Mannino Marina³⁴,Simonetti Luigi⁷,Toni Danilo²⁷,Mangiafico Salvatore⁴

Affiliation:

1. Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., S.F., E.F.M.C., B.B.).

2. NEUROFARBA Department, University of Florence, Firenze, Italy (G.P., D.I.).

3. Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy (V.S., L.A., T.T.).

4. NEUROFARBA Department, Careggi University Hospital, Firenze, Italy (S.N., P.N., S.M.).

5. Interventional Neuroradiology Unit and Stroke Unit, Policlinico Tor Vergata, Rome, Italy (L.G., F.S.).

6. Interventional Neuroradiology Unit and Stroke Unit, Ospedale Civile S. Agostino-Estense-University Hospital, Modena, Italy (S.V., G.B.).

7. Department of Neurology and Stroke Center, IRCCS Institute of the Neurological Sciences, Maggiore Hospital, Bologna, Italy (A.Z., L.S.).

8. Interventional Neuroradiology Unit and Stroke Unit, Policlinico G. Martino, Messina, Italy (A. Pitrone, F.G., R. Musolino).

9. Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy (S.B., R. Tinturini, R. Tassi).

10. Interventional Neuroradiology Unit and Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy (M.B., P.C.).

11. Neuroradiology Unit and Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy (A.S., A.D.V., I.C.).

12. Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy (R.G., M. Magoni).

13. Interventional Neuroradiology Unit and Stroke Unit, IRCCS San Martino-IST, Genova, Italy (L. Castellan, L.M.).

14. Interventional Neuroradiology Unit and Stroke Unit, Ospedale Universitario, Parma, Italy (R. Menozzi, U.S.).

15. Interventional Neuroradiology Unit and Stroke Unit, Azienda Ospedaliera-Universitaria, Padova, Italy (F.C., C.B.).

16. Vascular and Interventional Radiology Unit and Neurology Unit, Ospedale Civile Mazzini, Teramo, Italy (E.P., A. Casalena).

17. Neuroradiology Unit and Neurology Unit, Ospedale M. Bufalini, Cesena, Italy (M. Ruggiero, E.M.).

18. Interventional Neuroradiology Unit and Neurology Unit, Ospedale San Giovanni Bosco, Torino, Italy (C.C., G. Chianale).

19. Neuroradiology Unit and Neurology Unit, Ospedale Cisanello, Pisa, Italy (D.L.L., M. Mancuso).

20. Radiology, Diagnostic and Interventional Neuroradiology Unit, Policlinico IRCCS San Matteo, Pavia, Italy (E.L.).

21. Cerebrovascular Department, IRCCS Mondino Foundation, Pavia, Italy (A. Cavallini).

22. Neuroradiology Unit and Neurology Unit, Ospedale dell’Angelo-ULSS3 Serenissima, Mestre, Italy (N.C., A. Critelli).

23. Interventional Neuroradiology Unit and Stroke Unit, Azienda Ospedaliera Universitaria-Policlinico, Bari, Italy (L. Chiumarulo, M. Petruzzelli).

24. Neuroradiology Unit and Neurology Unit, Ospedale Universitario Circolo-ASST Sette Laghi, Varese, Italy (A.G., M.V.).

25. Interventional Neuroradiology Unit and Stroke Unit, Ospedale SS. Annunziata, Taranto, Italy (M.P.G., A.T.).

26. Interventional Neuroradiology Unit and Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy (W.A., A.P.).

27. Interventional Neuroradiology Unit and Stroke Unit, Sapienza University Hospital, Rome, Italy (G.G., E.N., D.T.).

28. Interventional Neuroradiology Unit and Stroke Unit, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy (P.F., S.S.).

29. Neuroradiology Unit and Neurology Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy (M. Pavia, P.I.).

30. Interventional Neuroradiology Unit and Stroke Unit, Humanitas Research Hospital, Rozzano, Italy (N.P.N., M.C.S.).

31. Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy (P.A., M. Russo).

32. Neuroradiology Unit and Neurology Unit, AO SS. Antonio e Biagio e C. Arrigo, Alessandria, Italy (D.F.).

33. Interventional Vascular Unit and Stroke Unit, Ospedale S. Michele-AO Brotzu, Cagliari, Italy (S.C.).

34. Interventional Neuroradiology Unit and Stroke Unit, Ospedale Civico-A.R.N.A.S., Palermo, Italy (G. Craparo, M.M.).

Abstract

Background and Purpose: As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA). Methods: We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Results: GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0–1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602–1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515–0.990). The rates of modified Rankin Scale score of 0–2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689–1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566–0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644–1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844–1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262–0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337–0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of <1, antiplatelet, and anticoagulant), differences were found also between GA versus CS as regards modified Rankin Scale score of 0–2 (aOR, 0.659 [95% CI, 0.538–0.807]) and GA versus LA as regards death (aOR, 1.413 [95% CI, 1.095–1.823]). Conclusions: GA during thrombectomy was associated with worse 3-month functional outcomes, especially when compared with LA. The inclusion of an LA arm in future randomized clinical trials of anesthesia strategy is recommended.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology

Reference20 articles.

1. A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke

2. Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke

3. Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke

4. Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection

5. Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke

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