Abstract
Background: Although several studies have compared conscious sedation (CS) with general anesthesia (GA) in patients undergoing mechanical thrombectomy (MT), there has been no affirmative conclusion. We conducted this trial to assess whether CS is superior to GA for patients undergoing MT for acute ischemic stroke (AIS).Methods: Acute ischemic stroke patients with anterior circulation large vascular occlusion were randomized into two groups. The primary outcome was modified Rankin scale score (0–2) at 90 days after stroke. Secondary outcomes included intraprocedural hemodynamics, time metrics, successful recanalization, neurointerventionalist satisfaction score, National Institutes of Health Stroke Scale (NIHSS) score, and Alberta Stroke Program Early CT Score (ASPECTS) at 48 h post-intervention, mortality at discharge and 3 months after stroke, and complications.Results: Compared with the CS group, heart rate was significantly lower at T1–T8 in the GA group except at T4 (P < 0.05). Mean arterial pressure (MAP) and systolic blood pressure were significantly lower in the GA group at T4–T6 and T9 (P < 0.05). Pulse oxygen saturation was significantly higher at T2–T9 in the GA group (P < 0.05). There were no significant differences in time metrics, vasoactive drug use, occurrence of >20% fall in MAP, pre-recanalization time spent with >20% fall in MAP, neurointerventionalist satisfaction, successful recanalization rate, NIHSS, and ASPECTS scores at 48 h post-intervention, and mortality rate at discharge and 3 months after stroke (P > 0.05). The cerebral infarction rate at 30 days was greater in the CS group, but not significantly (P > 0.05). There were no differences in complication rates except for pneumonia (P > 0.05). Conversion rate from CS to GA was 9.52%.Conclusion: Anesthetic management with GA or CS during MT had no differential impact on the functional outcomes and mortality at discharge or 3 months after stroke in AIS patients, but CS led to more stable hemodynamics and lower incidence of pneumonia.
Highlights
Acute ischemic stroke (AIS) is a leading cause of death and disability in China [1]
Patients were recruited between August 2017 and December 2018 if they met the following criteria: American Society of Anesthesiologists (ASA) grades I–III; National Institutes of Health Stroke Scale (NIHSS) score
Both mean arterial pressure (MAP) and systolic blood pressure were significantly lower in the general anesthesia (GA) group at T4–T6 and T9 (P < 0.05, Figure 3)
Summary
Acute ischemic stroke (AIS) is a leading cause of death and disability in China [1]. A typical AIS patient loses approximately 1.9 million neurons each minute if not treated promptly [2]. The primary goal of treatment in patients with AIS is to recanalize the brain as quickly and safely as possible [9]. Mechanical thrombectomy (MT) is an alternative to standard intravenous thrombolytic therapy for AIS patients who are disabled or who have other contraindications (such as recent surgery or coagulopathy) [11, 12]. Several studies have compared conscious sedation (CS) with general anesthesia (GA) in patients undergoing mechanical thrombectomy (MT), there has been no affirmative conclusion. We conducted this trial to assess whether CS is superior to GA for patients undergoing MT for acute ischemic stroke (AIS)
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