Abstract
Background and purpose: The optimal anesthetic management of acute ischemic stroke patients during mechanical thrombectomy (MT) remains controversial. In this post-hoc analysis, we investigated the impact of anesthesia type on clinical outcomes in patients included in SWIFT PRIME trial.Methods: Ninety-seven patients treated with MT were included. Patients treated in centers with general anesthesia (GA) policy (n = 32) were compared with those treated in centers with conscious sedation (CS) policy (n = 65). Primary outcomes studied included times to treatment initiation (TTI), rates of successful recanalization (TICI 2b/3), and functional independence (mRS 0–2 at 90 days). Secondary outcomes were adverse events, lowest systolic and diastolic blood pressures (LSBP and LDBP) during MT. Univariate analysis and multivariate regression logistic modeling were conducted.Results: The GA-policy and CS-policy groups presented comparable TTI (94 ± 36 min vs. 102 ± 48 min; p = 0.44), rates of TICI 2b/3 recanalization (22/32 [68.8%] vs. 51/65 [78.5%]; p = 0.32). CS-policy was associated to higher rate of functional independence than GA-policy, but the difference was not significant (43/65 [66.2%] vs. 16/32 [50.0%]; p = 0.18). GA-policy patients had a higher rate of postoperative pneumonia (11/32 [34.4%] vs. 8/65 [12.3%]; p = 0.02) and lower LSBP (110 [30,160] mmHg vs. 119 [77,170] mmHg; p = 0.03) and LDBP (55 (15,75) mmHg vs. 67 [40,121]; p < 0.001). When corrected for differences in baseline characteristics, GA-policy was associated with lower rate of functional independence (OR 0.32; p = 0.05). A 10-point increase in perprocedural LDBP was associated with an increased likelihood of favorable outcome (OR 1.51; p = 0.01).Conclusions: GA-policy for MT presented comparable TTI and rates of successful revascularization to CS-policy. However, GA-policy was associated with lower rates of functional independence and with higher incidence of perprocedural hypotension and postoperative pneumonia.Clinical Trial Registration: URL—http://www.clinicaltrials.gov. Unique identifier: NCT01657461
Highlights
The benefits of endovascular mechanical thrombectomy (MT) for patients with anterior circulation acute ischemic stroke (AIS) in terms of reperfusion success, safety, and clinical outcomes have been demonstrated by randomized trials [1,2,3,4,5]
In this post-hoc analysis, we investigated the impact of anesthetic management during MT on clinical outcomes based on a review of the clinical data from the centers included in the SWIFT PRIME trial [2]
The purpose of this study was to compare the rates of successful recanalization, procedural complications, and clinical outcomes including models appropriately corrected for differences in baseline characteristics, and the treatment initiation times (TTI) in anterior circulation AIS patients who received either general anesthesia (GA) or conscious sedation (CS) anesthetic management during MT
Summary
The benefits of endovascular mechanical thrombectomy (MT) for patients with anterior circulation acute ischemic stroke (AIS) in terms of reperfusion success, safety, and clinical outcomes have been demonstrated by randomized trials [1,2,3,4,5]. Many authors supported general anesthesia (GA) as the preferred method [6, 7], whereas others advocated using conscious sedation (CS) [8,9,10,11] Most of these works were retrospective, heterogeneously designed and presented significant limitations, such as limited sample sizes, possible sampling bias, different and variable anesthetic drugs and/or blood pressure (BP) managements that make it difficult to draw definite and reliable conclusions [8,9,10,11,12,13]. The optimal anesthetic management of acute ischemic stroke patients during mechanical thrombectomy (MT) remains controversial In this posthoc analysis, we investigated the impact of anesthesia type on clinical outcomes in patients included in SWIFT PRIME trial
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