Endovascular Treatment for Acute Ischemic Stroke With or Without General Anesthesia: A Matched Comparison-Reference-Cited by-同舟云学术

Endovascular Treatment for Acute Ischemic Stroke With or Without General Anesthesia: A Matched Comparison

Published:2022-05 Issue:5 Volume:53 Page:1520-1529
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Wagner Benjamin¹^ORCID,Lorscheider Johannes¹^ORCID,Wiencierz Andrea²^ORCID,Blackham Kristine³^ORCID,Psychogios Marios³^ORCID,Bolliger Daniel⁴^ORCID,De Marchis Gian Marco¹,Engelter Stefan T.¹⁵^ORCID,Lyrer Philippe¹^ORCID,Wright Patrick R.²^ORCID,Fischer Urs⁶^ORCID,Mordasini Pasquale,Nannoni Stefania⁷^ORCID,Puccinelli Francesco⁷,Kahles Timo⁸^ORCID,Bianco Giovanni⁹^ORCID,Carrera Emmanuel¹⁰^ORCID,Luft Andreas R.¹¹¹²^ORCID,Cereda Carlo W.⁹^ORCID,Kägi Georg¹³^ORCID,Weber Johannes¹⁴^ORCID,Nedeltchev Krassen⁸,Michel Patrik¹⁵⁷^ORCID,Gralla Jan¹⁵,Arnold Marcel⁶,Bonati Leo H.¹¹⁶^ORCID,Anon Javier,Clarke Sandra,Diepers Michael,Gruber Philipp,Martin Eileen,Remonda Luca,Schweikert Andreas,Zupa. Vedrana,Altersberger Valerian,Brehm Alex,Dittrich Tolga,El Mekabaty Amgad,Fladt Joachim,Fisch Urs,Gensicke Henrik,Hert Lisa,Manuzzi Sabrina,Maurer Marina,Meya Louisa,Peters Nils,Polymeris Alexandros,Thilemann Sebastian,Traenka Christopher,Tsogkas Ioannes,Zietz Anaelle,Goeldlin Martina,Heldner Mirjam,Jung Simon,Kaesmacher Johannes,Mamaari Basel,Meinel Thomas,Mueller Madlaine,Sarykaya Hakan,Seiffge David,Siepen Bernhard,Vynkier Jan,Eskandari Ashraf,Pantazou Vasiliki,Strambo Davide,Frangi Jane,Sihabdeen Shairin,Vehoff Jochen,Katan Mira,Mueller Achim,Wegener Susanne

Affiliation:

1. Department of Neurology (B.W., J.L., G.M.D.M., S.T.E., P.L., L.H.B.), University Hospital Basel and University of Basel, Switzerland.

2. Clinical Trial Unit (A.W., P.R.W.), University Hospital Basel and University of Basel, Switzerland.

3. Institute of Diagnostic and Interventional Neuroradiology (K.B., M.P.), University Hospital Basel and University of Basel, Switzerland.

4. Department of Anesthesiology (D.B.), University Hospital Basel and University of Basel, Switzerland.

5. Neurology and Neurorehabilitation, University Department of Geriatic Medicine FELIX PLATTER and Department of Clinical Research, University of Basel, Switzerland (S.T.E.).

6. Department of Neurology (U.F., M.A.), Inselspital, Bern University Hospital, University of Bern, Switzerland.

7. Department of Neurology, Lausanne University Hospital, Switzerland (S.N., F.P., P.M.).

8. Department of Neurology, Cantonal Hospital Aarau, Switzerland (T.K., K.N.).

9. Stroke Center EOC, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano (G.B., C.W.C.).

10. Department of Neurology, University Hospital Geneva, Switzerland (E.C.).

11. Department of Neurology, University Hospital Zurich, Switzerland (A.R.L.).

12. Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.R.L.).

13. Department of Neurology (G.K.), Cantonal Hospital St. Gallen, Switzerland.

14. Institute of Diagnostic and Interventional Neuroradiology (J.W.), Cantonal Hospital St. Gallen, Switzerland.

15. Institute of Diagnostic and Interventional Neuroradiology (P.M., J.G.), Inselspital, Bern University Hospital, University of Bern, Switzerland.

16. Research Department, Reha Rheinfelden, Switzerland (L.H.B.).

Abstract

Background: Endovascular treatment in large artery occlusion stroke reduces disability. However, the impact of anesthesia type on clinical outcomes remains uncertain. Methods: We compared consecutive patients in the Swiss Stroke Registry with anterior circulation stroke receiving endovascular treatment with or without general anesthesia (GA). The primary outcome was disability on the modified Rankin Scale after 3 months, analyzed with ordered logistic regression. Secondary outcomes included dependency or death (modified Rankin Scale score ≥ 3), National Institutes of Health Stroke Scale after 24 hours, symptomatic intracranial hemorrhage with ≥ 4 points worsening on National Institutes of Health Stroke Scale within 7 days, and mortality. Coarsened exact matching and propensity score matching were performed to adjust for indication bias. Results: One thousand two hundred eighty-four patients (GA: n=851, non-GA: n=433) from 8 Stroke Centers were included. Patients treated with GA had higher modified Rankin Scale scores after 3 months than patients treated without GA, in the unmatched (odds ratio [OR], 1.75 [1.42–2.16]; P <0.001), the coarsened exact matching (n=332–524, using multiple imputations of missing values; OR, 1.60 [1.08–2.36]; P =0.020), and the propensity score matching analysis (n=568; OR, 1.61 [1.20–2.15]; P =0.001). In the coarsened exact matching analysis, there were no significant differences in National Institutes of Health Stroke Scale after 1 day (estimated coefficient 2.61 [0.59–4.64]), symptomatic intracranial hemorrhage (OR, 1.06 [0.30–3.75]), dependency or death (OR, 1.42 [0.91–2.23]), or mortality (OR, 1.65 [0.94–2.89]). In the propensity score matching analysis, National Institutes of Health Stroke Scale after 24 hours (estimated coefficient, 3.40 [1.76–5.04]), dependency or death (OR, 1.49 [1.07–2.07]), and mortality (OR, 1.65 [1.11–2.45]) were higher in the GA group, whereas symptomatic intracranial hemorrhage did not differ significantly (OR, 1.77 [0.73–4.29]). Conclusions: This large study showed worse functional outcome after endovascular treatment of anterior circulation stroke with GA than without GA in a real-world setting. This finding appears to be independent of known differences in patient characteristics between groups.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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