BACKGROUND AND PURPOSE: Patients undergoing intra-arterial therapy (IAT) for acute ischemic stroke receive either general anesthesia (GA) or conscious sedation. GA may delay time to treatment, whereas conscious sedation may result in patient movement and compromise the safety of the procedure. We sought to determine whether there were differences in safety and outcomes in GA patients before initiation of IAT. METHODS: A cohort of 980 patients at 12 stroke centers underwent IAT for acute stroke between 2005 and 2009. Only patients with anterior circulation strokes due to large-vessel occlusion were included in the study. A binary logistic-regression model was used to determine independent predictors of good outcome and death. RESULTS: The mean age was 66+/-15 years and median National Institutes of Health Stroke Scale score was 17 (interquartile range, 13-20). The overall recanalization rate was 68% and the symptomatic hemorrhage rate was 9.2%. GA was used in 44% of patients with no differences in intracranial hemorrhage rates when compared with the conscious sedation group. The use of GA was associated with poorer neurologic outcome at 90 days (odds ratio=2.33; 95% CI, 1.63-3.44; P<0.0001) and higher mortality (odds ratio=1.68; 95% CI, 1.23-2.30; P<0.0001) compared with conscious sedation. CONCLUSIONS: Patients placed under GA during IAT for anterior circulation stroke appear to have a higher chance of poor neurologic outcome and mortality. There do not appear to be differences in hemorrhagic complications between the 2 groups. Future clinical trials with IAT can help elucidate the etiology of the differences in outcomes.
BACKGROUND AND PURPOSE:Patients undergoing intra-arterial therapy (IAT) for acute ischemic stroke receive either general anesthesia (GA) or conscious sedation. GA may delay time to treatment, whereas conscious sedation may result in patient movement and compromise the safety of the procedure. We sought to determine whether there were differences in safety and outcomes in GA patients before initiation of IAT. METHODS: A cohort of 980 patients at 12 stroke centers underwent IAT for acute stroke between 2005 and 2009. Only patients with anterior circulation strokes due to large-vessel occlusion were included in the study. A binary logistic-regression model was used to determine independent predictors of good outcome and death. RESULTS: The mean age was 66+/-15 years and median National Institutes of Health Stroke Scale score was 17 (interquartile range, 13-20). The overall recanalization rate was 68% and the symptomatic hemorrhage rate was 9.2%. GA was used in 44% of patients with no differences in intracranial hemorrhage rates when compared with the conscious sedation group. The use of GA was associated with poorer neurologic outcome at 90 days (odds ratio=2.33; 95% CI, 1.63-3.44; P<0.0001) and higher mortality (odds ratio=1.68; 95% CI, 1.23-2.30; P<0.0001) compared with conscious sedation. CONCLUSIONS:Patients placed under GA during IAT for anterior circulation stroke appear to have a higher chance of poor neurologic outcome and mortality. There do not appear to be differences in hemorrhagic complications between the 2 groups. Future clinical trials with IAT can help elucidate the etiology of the differences in outcomes.
Authors: W Brinjikji; M H Murad; A A Rabinstein; H J Cloft; G Lanzino; D F Kallmes Journal: AJNR Am J Neuroradiol Date: 2014-11-13 Impact factor: 3.825
Authors: Oliver Herrmann; Andreas Hug; Julian Bösel; Juliana Johanna Petersen; Marius Hartmann; Stefan Rohde; Martin Bendszus; Peter Arthur Ringleb; Werner Hacke; Roland Veltkamp Journal: Neurocrit Care Date: 2012-12 Impact factor: 3.210
Authors: Rob A van de Graaf; Noor Samuels; Maxim J H L Mulder; Ismail Eralp; Adriaan C G M van Es; Diederik W J Dippel; Aad van der Lugt; Bart J Emmer Journal: Neurology Date: 2018-06-01 Impact factor: 9.910
Authors: Raul G Nogueira; Rishi Gupta; Tudor G Jovin; Elad I Levy; David S Liebeskind; Osama O Zaidat; Ansaar Rai; Joshua A Hirsch; Daniel P Hsu; Marilyn M Rymer; Ashis H Tayal; Ridwan Lin; Sabareesh K Natarajan; Ashish Nanda; Melissa Tian; Qing Hao; Junaid S Kalia; Michael Chen; Alex Abou-Chebl; Thanh N Nguyen; Albert J Yoo Journal: J Neurointerv Surg Date: 2014-01-08 Impact factor: 5.836