Alex Abou-Chebl1, Ossama O Zaidat, Alicia C Castonguay, Rishi Gupta, Chung-Huan J Sun, Coleman O Martin, William E Holloway, Nils Mueller-Kronast, Joey D English, Italo Linfante, Guilherme Dabus, Timothy W Malisch, Franklin A Marden, Hormozd Bozorgchami, Andrew Xavier, Ansaar T Rai, Micahel T Froehler, Aamir Badruddin, Thanh N Nguyen, Muhammad Taqi, Michael G Abraham, Vallabh Janardhan, Hashem Shaltoni, Roberta Novakovic, Albert J Yoo, Peng R Chen, Gavin W Britz, Ritesh Kaushal, Ashish Nanda, Mohammad A Issa, Raul G Nogueira. 1. From the Texas Stroke Institute, Plano, TX (A.A.-C., V.J.); Departments of Neurology, Neurosurgery, and Radiology, Medical College of Wisconsin/Froedtert Hospital, Atlanta, GA (O.O.Z., A.C.C., M.A.I.); Wellstar Neurosurgery Kennestone Hospital, Atlanta, GA (R.G.); Department of Neurology, Emory University School of Medicine, Atlanta, GA (C.-H.J.S. R.G.N.); Saint Luke's Kansas City, Kansas City, MO (C.O.M., W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K.); California Pacific Medical Center, San Francisco, CA (J.D.E.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Alexian Brothers Medical Center, Elk Grove Village, IL (T.W.M., F.A.M.); Oregon Health and Science University, Portland, OR (H.B.); Department of Neurology, Wayne State University School of Medicine, Detroit, MI (A.X.); Department of Radiology, West Virginia University Hospital, Morgantown, WV (A.T.R.); Departments of Neurology, Neurosurgery, Radiology, Vanderbilt University Medical Center, Nashville, TN (M.T.F.); Provena Saint Joseph Medical Center, Joliet, IL (A.B.); Departments of Neurology, Neurosurgery, Radiology, Boston Medical Center, Boston, MA (T.N.N.); Desert Regional Medical Center, Palm Springs, CA (M.T.); University of Kansas Medical Center, Kansas City, KS (M.G.A.); University of Texas Health Science Center, Houston, TX (H.S.); Departments of Radiology, Neurology, UT Southwestern Medical Center, Dallas, TX (R.N.); Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA (A.J.Y.); University of Texas, Houston, TX (P.R.C.); Department of Neurosurgery, Houston Methodist, Methodist Neurological Institute, Houston, TX (G.W.B.); Saint Louis University, St. Louis, MO (R.K.); and University of Missouri, Columbia, MO (A.N.).
Abstract
BACKGROUND AND PURPOSE: Previous work that predated the availability of the safer stent-retriever devices has suggested that general anesthesia (GA) may have a negative impact on outcomes in patients with acute ischemic stroke undergoing endovascular therapy. METHODS: We reviewed demographic, clinical, procedural (GA versus local anesthesia [LA], etc), and site-adjudicated angiographic and clinical outcomes data from consecutive patients treated with the Solitaire FR device in the investigator-initiated North American SOLITAIRE Stent-Retriever Acute Stroke (NASA) Registry. The primary outcomes were 90-day modified Rankin Scale, mortality, and symptomatic intracranial hemorrhage. RESULTS: A total of 281 patients from 18 centers were enrolled. GA was used in 69.8% (196/281) of patients. Baseline demographic and procedural factors were comparable between the LA and GA groups, except the former demonstrated longer time-to-groin puncture (395.4±254 versus 337.4±208 min; P=0.04), lower National Institutes of Health Stroke Scale (NIHSS; 16.2±5.8 versus 18.8±6.9; P=0.002), lower balloon-guide catheter usage (22.4% versus 49.2%; P=0.0001), and longer fluoroscopy times (39.5±33 versus 28±22.8 min; P=0.008). Recanalization (thrombolysis in cerebral infarction ≥2b; 72.94% versus 73.6%; P=0.9) and rate of symptomatic intracranial hemorrhage (7.1% versus 11.2%; P=0.4) were similar but modified Rankin Scale ≤2 was achieved in more LA patients, 52.6% versus 35.6% (odds ratio, 1.4 [1.1-1.8]; P=0.01). In multivariate analysis, hypertension, NIHSS, unsuccessful revascularization, and GA use (odds ratio, 3.3 [1.6-7.1]; P=0.001) were associated with death. When only anterior circulation and elective GA patients were included, there was a persistent difference in good outcomes in favor of LA patients (50.7% versus 35.5%; odds ratio, 1.3 [1.01-1.6]; P=0.04). CONCLUSIONS: The NASA Registry has demonstrated that clinical outcomes and survival are significantly better in patients treated with LA, without increased symptomatic intracranial hemorrhage risk. Future trials should prospectively evaluate the effect of GA on outcomes.
BACKGROUND AND PURPOSE: Previous work that predated the availability of the safer stent-retriever devices has suggested that general anesthesia (GA) may have a negative impact on outcomes in patients with acute ischemic stroke undergoing endovascular therapy. METHODS: We reviewed demographic, clinical, procedural (GA versus local anesthesia [LA], etc), and site-adjudicated angiographic and clinical outcomes data from consecutive patients treated with the Solitaire FR device in the investigator-initiated North American SOLITAIRE Stent-Retriever Acute Stroke (NASA) Registry. The primary outcomes were 90-day modified Rankin Scale, mortality, and symptomatic intracranial hemorrhage. RESULTS: A total of 281 patients from 18 centers were enrolled. GA was used in 69.8% (196/281) of patients. Baseline demographic and procedural factors were comparable between the LA and GA groups, except the former demonstrated longer time-to-groin puncture (395.4±254 versus 337.4±208 min; P=0.04), lower National Institutes of Health Stroke Scale (NIHSS; 16.2±5.8 versus 18.8±6.9; P=0.002), lower balloon-guide catheter usage (22.4% versus 49.2%; P=0.0001), and longer fluoroscopy times (39.5±33 versus 28±22.8 min; P=0.008). Recanalization (thrombolysis in cerebral infarction ≥2b; 72.94% versus 73.6%; P=0.9) and rate of symptomatic intracranial hemorrhage (7.1% versus 11.2%; P=0.4) were similar but modified Rankin Scale ≤2 was achieved in more LA patients, 52.6% versus 35.6% (odds ratio, 1.4 [1.1-1.8]; P=0.01). In multivariate analysis, hypertension, NIHSS, unsuccessful revascularization, and GA use (odds ratio, 3.3 [1.6-7.1]; P=0.001) were associated with death. When only anterior circulation and elective GA patients were included, there was a persistent difference in good outcomes in favor of LA patients (50.7% versus 35.5%; odds ratio, 1.3 [1.01-1.6]; P=0.04). CONCLUSIONS: The NASA Registry has demonstrated that clinical outcomes and survival are significantly better in patients treated with LA, without increased symptomatic intracranial hemorrhage risk. Future trials should prospectively evaluate the effect of GA on outcomes.
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Authors: M K Whalin; K M Halenda; D C Haussen; L C Rebello; M R Frankel; R Y Gershon; R G Nogueira Journal: AJNR Am J Neuroradiol Date: 2016-11-03 Impact factor: 3.825
Authors: Alex Abou-Chebl; Sharon D Yeatts; Bernard Yan; Kevin Cockroft; Mayank Goyal; Tudor Jovin; Pooja Khatri; Phillip Meyers; Judith Spilker; Rebecca Sugg; Katja E Wartenberg; Tom Tomsick; Joe Broderick; Michael D Hill Journal: Stroke Date: 2015-07-02 Impact factor: 7.914
Authors: Raul G Nogueira; Osama O Zaidat; Alicia C Castonguay; Diogo C Haussen; Coleman O Martin; William E Holloway; Nils Mueller-Kronast; Joey English; Italo Linfante; Guilherme Dabus; Tim W Malisch; Franklin A Marden; Hormozd Bozorgchami; Andrew Xavier; Ansaar T Rai; Michael T Froehler; Aamir Badruddin; Thanh N Nguyen; M Asif Taqi; Michael G Abraham; Vallabh Janardhan; Albert J Yoo; Hashem Shaltoni; Alex Abou-Chebl; Peng R Chen; Gavin W Britz; Roberta Novakovic; Ashish Nanda; Ritesh Kaushal; Mohammad A Issa; Michael R Frankel; Rishi Gupta Journal: Interv Neurol Date: 2016-05-27