Robert-Jan B Goldhoorn1, Marie Louise E Bernsen2, Jeannette Hofmeijer2, Jasper M Martens2, Hester F Lingsma2, Diederik W J Dippel2, Aad van der Lugt2, Wolfgang F F A Buhre2, Yvo B W E M Roos2, Charles B L M Majoie2, Jan Albert Vos2, Jelis Boiten2, Bart Emmer2, Robert J van Oostenbrugge2, Wim H van Zwam2. 1. From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands. robertjan.goldhoorn@mumc.nl. 2. From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands.
Abstract
OBJECTIVE: To compare outcomes after endovascular treatment (EVT) for acute ischemic stroke with 3 different types of anesthetic management in clinical practice, as anesthetic management may influence functional outcome. METHODS: Data of patients with an anterior circulation occlusion, included in the Dutch nationwide, prospective Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry between March 2014 and June 2016, were analyzed. Patients were divided into 3 groups defined by anesthetic technique performed during EVT: local anesthesia only (LA), general anesthesia (GA), or conscious sedation (CS). Primary outcome was the modified Rankin Scale score at 90 days. To compare functional outcome between groups, we estimated a common odds ratio (OR) with ordinal logistic regression, adjusted for age, sex, prestroke modified Rankin Scale score, baseline NIH Stroke Scale score, collaterals, and time from onset to arrival at intervention center. RESULTS:A total of 1,376 patients were included. Performed anesthetic technique was LA in 821 (60%), GA in 381 (28%), and CS in 174 (13%) patients. Compared to LA, both GA and CS were associated with worse functional outcome on the modified Rankin Scale score at 90 days (GA cORadj 0.75; 95% confidence interval [CI] 0.58-0.97; CS cORadj 0.45; 95% CI 0.33-0.62). CS was associated with worse functional outcome than GA (cORadj 0.60; 95% CI 0.42-0.87). CONCLUSIONS:LA is associated with better functional outcome than systemic sedation in patients undergoing EVT for acute ischemic stroke. Whereas LA had a clear advantage over CS, this was less prominent compared to GA. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with acute ischemic stroke undergoingEVT, LA improves functional outcome compared to GA or CS.
RCT Entities:
OBJECTIVE: To compare outcomes after endovascular treatment (EVT) for acute ischemic stroke with 3 different types of anesthetic management in clinical practice, as anesthetic management may influence functional outcome. METHODS: Data of patients with an anterior circulation occlusion, included in the Dutch nationwide, prospective Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry between March 2014 and June 2016, were analyzed. Patients were divided into 3 groups defined by anesthetic technique performed during EVT: local anesthesia only (LA), general anesthesia (GA), or conscious sedation (CS). Primary outcome was the modified Rankin Scale score at 90 days. To compare functional outcome between groups, we estimated a common odds ratio (OR) with ordinal logistic regression, adjusted for age, sex, prestroke modified Rankin Scale score, baseline NIH Stroke Scale score, collaterals, and time from onset to arrival at intervention center. RESULTS: A total of 1,376 patients were included. Performed anesthetic technique was LA in 821 (60%), GA in 381 (28%), and CS in 174 (13%) patients. Compared to LA, both GA and CS were associated with worse functional outcome on the modified Rankin Scale score at 90 days (GA cORadj 0.75; 95% confidence interval [CI] 0.58-0.97; CS cORadj 0.45; 95% CI 0.33-0.62). CS was associated with worse functional outcome than GA (cORadj 0.60; 95% CI 0.42-0.87). CONCLUSIONS: LA is associated with better functional outcome than systemic sedation in patients undergoing EVT for acute ischemic stroke. Whereas LA had a clear advantage over CS, this was less prominent compared to GA. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with acute ischemic stroke undergoing EVT, LA improves functional outcome compared to GA or CS.
Authors: Renato Tosello; Rachel Riera; Giuliano Tosello; Caroline Nb Clezar; Jorge E Amorim; Vladimir Vasconcelos; Benedito B Joao; Ronald Lg Flumignan Journal: Cochrane Database Syst Rev Date: 2022-07-20
Authors: Katharina Feil; Moriz Herzberg; Franziska Dorn; Steffen Tiedt; Clemens Küpper; Dennis C Thunstedt; Ludwig C Hinske; Konstanze Mühlbauer; Sebastian Goss; Thomas Liebig; Marianne Dieterich; Andreas Bayer; Lars Kellert Journal: J Stroke Date: 2021-01-31 Impact factor: 6.967
Authors: Kars C J Compagne; Manon Kappelhof; Wouter H Hinsenveld; Josje Brouwer; Robert-Jan B Goldhoorn; Maarten Uyttenboogaart; Reinoud P H Bokkers; Wouter J Schonewille; Jasper M Martens; Jeannette Hofmeijer; H Bart van der Worp; Rob T H Lo; Koos Keizer; Lonneke S F Yo; Geert J Lycklama À Nijeholt; Heleen M den Hertog; Emiel J C Sturm; Paul J A M Brouwers; Marianne A A van Walderveen; Marieke J H Wermer; Sebastiaan F de Bruijn; Lukas C van Dijk; Hieronymus D Boogaarts; Ewout J van Dijk; Julia H van Tuijl; Jo P P Peluso; Paul L M de Kort; Boudewijn A A M van Hasselt; Puck S Fransen; Tobien H C M L Schreuder; Roel J J Heijboer; Sjoerd F M Jenniskens; Marieke E S Sprengers; Elias Ghariq; Ido R van den Wijngaard; Stefan D Roosendaal; Anton F J A Meijer; Ludo F M Beenen; Alida A Postma; René van den Berg; Albert J Yoo; Pieter Jan van Doormaal; Marc P van Proosdij; Menno G M Krietemeijer; Dick G Gerrits; Sebastiaan Hammer; Jan Albert Vos; Jelis Boiten; Jonathan M Coutinho; Bart J Emmer; Ad C G M van Es; Bob Roozenbeek; Yvo B W E M Roos; Wim H van Zwam; Robert J van Oostenbrugge; Charles B L M Majoie; Diederik W J Dippel; Aad van der Lugt Journal: Stroke Date: 2022-02-09 Impact factor: 10.170
Authors: Manon Kappelhof; Johanna M Ospel; Petra Cimflova; Nima Kashani; Nishita Singh; Rosalie McDonough; Arshia Sehgal; Mohammed A Almekhlafi; Jens Fiehler; Michael Chen; Nobuyuki Sakai; Charles Blm Majoie; Mayank Goyal Journal: Interv Neuroradiol Date: 2021-10-19 Impact factor: 1.764
Authors: Noor Samuels; Rob A van de Graaf; Carlijn A L van den Berg; Daan Nieboer; Ismail Eralp; Kilian M Treurniet; Bart J Emmer; Rogier V Immink; Charles B L M Majoie; Wim H van Zwam; Reinoud P H Bokkers; Maarten Uyttenboogaart; Boudewijn A A M van Hasselt; Jörg Mühling; James F Burke; Bob Roozenbeek; Aad van der Lugt; Diederik W J Dippel; Hester F Lingsma; Adriaan C G M van Es Journal: Neurology Date: 2020-10-07 Impact factor: 9.910