Abstract WP4: Conscious Sedation With Dexmedetomidine For Acute Stroke Patients Undergoing Intrarterial Therapy.

Abstract

Background: The aim of this pilot study was to prospectively determine safety and feasibility of Conscious sedation (CS) with dexmedetomidine in stroke patients undergoing intra-arterial therapy (IAT). Methods: This industry sponsored prospective single arm study was conducted with institutional IRB approval. The following data points were collected: demographics, pre-procedure NIHSS, mean time to treatment, treatment modalities, sedation and procedure times and the use of adjunctive sedation medications. Outcome measures included intraprocedural pain scores and Richmond agitation sedation scale (RASS), recanalization score, intraprocedural complications, conversion to GA, modified Rankin scale at 30 days as well as a personal account of the patients experience during the procedure. Results: Fifty- one patients were enrolled in this study of which 41 patients underwent acute stroke therapy and were included in this analysis. Baseline characteristics are included in table 1. Site of occlusion was the MCA in 27 patients, ICA-terminus in 10 patients and BA in 4 patients. IAT was performed using the MERCI device in 30 patients, Penumbra device in 3, manual aspiration in 5, and angioplasty and stenting in 3 patients. Adjunctive IA tPA was administered in 6 patients. All patients tolerated treatment under CS. The mean procedural RASS was 0 and the mean pain score was 1. Thrombolysis in Cerebral Ischemia (TICI) 2B/3 recanalization was achieved in 32 patients (78%). Two intra-procedural wire perforations (5%) were recorded. Ten patients (24%) had a mRs of < 2 at 30 days and 6 patients died (14%). Thirty-one patients described their experience. Only 6 patients were able to remember having the procedure of which 1 had a negative experience. Conclusion: To our knowledge, this is the first prospective study to evaluate the safety and efficacy of CS in stroke patients who undergo IAT. In our cohort, CS was safe, feasible and well tolerated.