Abstract W P12: Intra-procedural Hemodynamics in General Anesthesia versus Monitored Anesthesia Care During Endovascular Therapy for Acute Anterior Circulation Ischemic Stroke

Abstract

Background: Recent studies have identified general anesthesia (GA) as a predictor of poor outcome compared to non-intubated sedation techniques during intra-arterial therapy (IAT) for acute ischemic stroke (AIS). Factors contributing to this difference are not well understood. Objective: Identify factors associated with poor outcome in patients receiving GA vs Monitored Anesthesia Care (MAC). We speculated that peri-procedural blood pressure (BP) may be influenced by anesthesia and could plausibly contribute to differences in outcome. Methods: 190 patients who underwent IAT for anterior circulation AIS from 1/2008 to 12/2012 were included. Patients <18 years of age and posterior circulation AIS were excluded. Demographics, NIHSS, IV tPA use, use of GA/MAC, thrombus location, recanalization grade, post-procedure intracranial hemorrhage (ICH), and 30-day outcomes were collected. Intra-procedural hemodynamics including maximum/minimum heart rate and systolic/diastolic/mean BP were collected. Primary outcomes were in-hospital mortality and good outcome (mRS 0-2) at 30 days. Secondary outcomes were successful recanalization (TICI 2b-3) and ICH (PH1+2) based on ECASS definitions. Results: There were 91 and 99 patients in the GA and MAC groups respectively. Baseline characteristics including NIHSS scores were similar between both groups. The GA group had more ICA terminus occlusions (39.1% vs 18.2%, p = 0.043). There was significantly higher mortality (25.8% vs 13.3%, p = 0.040) and a trend towards poorer outcome (14.9% vs 22.8% with mRS 0-2, p = 0.239) in the GA group. Successful recanalization was higher in the GA group (57.1% vs 47.5%, p = 0.182), but the rate of PH1+2 ICH was significantly higher in the GA group (26.3% vs 10.1%, p = 0.003). There were no significant differences in intra-procedural hemodynamics, prior to or after recanalization. GA was an independent predictor of mortality and PH1+2 ICH. Conclusions: Patients placed under GA prior to IAT appear to have a higher probability of mortality and a trend towards poorer outcome. Outcome differences do not seem to be related to hemodynamic factors. There were significantly higher number of ICHs in the GA group and this could potentially be the factor driving the difference between outcomes.