Abstract
ObjectiveTo date, no consensus still exists on the anesthesia strategy of endovascular treatment (EVT) for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). We aimed to compare the 90-day outcomes, puncture-to-recanalization time (PRT), successful recanalization rate, and symptomatic intracranial hemorrhage (sICH) of patients undergoing general anesthesia (GA) or local anesthesia (LA) ± conscious sedation (CS) during the procedure.MethodsWe selected patients from the Acute Ischemic Stroke Cooperation Group of Endovascular Treatment (ANGEL) registry and divided them into the GA group and the LA ± CS group. The two groups underwent 1:1 matching under propensity score matching (PSM) analysis. Then, we compared the primary outcome including the 90-day modified Rankin Scale (mRS) 0–2, secondary outcome including the 90-day mRS, the 90-day mRS 0–1, the 90-day mRS 0–3, PRT, and successful recanalization rate as well as the safety outcome including sICH, any ICH, and 90-day mRS 6.ResultsAmong the 705 enrolled patients, 263 patients underwent GA and 442 patients underwent LA ± CS. After 1:1 PSM according to the baseline characteristics, each group has 216 patients. Patients with GA had the higher median 90-day mRS [3 (1–5) vs. 2 (1–4), p < 0.001], the lower 90-day mRS 0–2 rate (43.5 vs. 56.5%, p = 0.007), higher mortality (19.9 vs.10.2%, p = 0.005), and longer PRT [92 (60–140) vs. 70 (45–103) min, p < 0.001]. There were no differences in sICH and successful recanalization rate between both the groups.ConclusionIn the real-world setting, LA ± CS might provide more outcomes benefits than GA in patients with AIS-LVO during the procedure.
Highlights
Endovascular treatment (EVT) has become the standard for acute ischemic stroke (AIS) due to large vessel occlusion (LVO) [1,2,3,4,5]
Inclusion criteria in this study were described as the following: [1] Age more than 18 years; [2] Clinical diagnosis of ischemic stroke in which the stroke symptoms last for more than 30 min and no improvement prior to treatment; [3] The modified Rankin Scale less than 2 before the current stroke; [4] Large vessel occlusion in the internal carotid artery (ICA), middle cerebral artery (MCA) (M1/M2 segment), and anterior cerebral artery (ACA); and [5] Informed consent form was obtained from the patient or legally authorized representative of the patient after receiving information about data collection
Antiplatelet therapy was significantly different before EVT, intravenous thrombolysis (IVT) before EVT, the admission National Institutes of Health Stroke Scale (NIHSS), the admission Alberta Stroke Program Early CT Score (ASPECTS), tandem occlusion, large artery atherosclerosis (LAA) subtype, CE subtype, and time from door to puncture between the two groups
Summary
Endovascular treatment (EVT) has become the standard for acute ischemic stroke (AIS) due to large vessel occlusion (LVO) [1,2,3,4,5]. Three well-known randomized controlled trials (RCTs) [Sedation vs Intubation for Endovascular Stroke Treatment (SIESTA), General or Local Anesthesia in Intra Arterial Therapy (GOLIATH), and Anesthesia During Stroke (ANSTROKE)] showed no significant difference in the outcome between different anesthetic approaches [6,7,8]. A metaanalysis of these three trials demonstrated different results; the use of protocol-based general anesthesia (GA) was significantly associated with less disability at 3 months [9]. Analysis from the Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES) collaborators demonstrated an association between poor outcome and GA [10]. The finding from the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke (DEFUSE 3) trial posthoc analysis supported this result [11]
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