Manuel Cappellari1, Giovanni Pracucci2, Stefano Forlivesi1, Valentina Saia3, Sergio Nappini4, Patrizia Nencini4, Domenico Inzitari2, Laura Greco5, Fabrizio Sallustio5, Stefano Vallone6, Guido Bigliardi6, Andrea Zini7, Antonio Pitrone8, Francesco Grillo8, Rosa Musolino8, Sandra Bracco9, Rebecca Tinturini9, Rossana Tassi9, Mauro Bergui10, Paolo Cerrato10, Andrea Saletti11, Alessandro De Vito11, Ilaria Casetta11, Roberto Gasparotti12, Mauro Magoni12, Lucio Castellan13, Laura Malfatto13, Roberto Menozzi14, Umberto Scoditti14, Francesco Causin15, Claudio Baracchini15, Edoardo Puglielli16, Alfonsina Casalena16, Maria Ruggiero17, Emanuele Malatesta17, Chiara Comelli18, Gigliola Chianale18, Dario Luca Lauretti19, Michelangelo Mancuso19, Elvis Lafe20, Anna Cavallini21, Nicola Cavasin22, Adriana Critelli22, Elisa Francesca Maria Ciceri1, Bruno Bonetti1, Luigi Chiumarulo23, Marco Petruzzelli23, Andrea Giorgianni24, Maurizio Versino24, Maria Porzia Ganimede25, Angelica Tinelli25, Wiliam Auteri26, Alfredo Petrone26, Giulio Guidetti27, Ettore Nicolini27, Luca Allegretti3, Tiziana Tassinari3, Pietro Filauri28, Simona Sacco28, Marco Pavia29, Paolo Invernizzi29, Nunzio Paolo Nuzzi30, Maria Carmela Spinelli30, Pietro Amistà31, Monia Russo31, Delfina Ferrandi32, Simona Corraine33, Giuseppe Craparo34, Marina Mannino34, Luigi Simonetti7, Danilo Toni27, Salvatore Mangiafico4. 1. Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., S.F., E.F.M.C., B.B.). 2. NEUROFARBA Department, University of Florence, Firenze, Italy (G.P., D.I.). 3. Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy (V.S., L.A., T.T.). 4. NEUROFARBA Department, Careggi University Hospital, Firenze, Italy (S.N., P.N., S.M.). 5. Interventional Neuroradiology Unit and Stroke Unit, Policlinico Tor Vergata, Rome, Italy (L.G., F.S.). 6. Interventional Neuroradiology Unit and Stroke Unit, Ospedale Civile S. Agostino-Estense-University Hospital, Modena, Italy (S.V., G.B.). 7. Department of Neurology and Stroke Center, IRCCS Institute of the Neurological Sciences, Maggiore Hospital, Bologna, Italy (A.Z., L.S.). 8. Interventional Neuroradiology Unit and Stroke Unit, Policlinico G. Martino, Messina, Italy (A. Pitrone, F.G., R. Musolino). 9. Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy (S.B., R. Tinturini, R. Tassi). 10. Interventional Neuroradiology Unit and Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy (M.B., P.C.). 11. Neuroradiology Unit and Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy (A.S., A.D.V., I.C.). 12. Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy (R.G., M. Magoni). 13. Interventional Neuroradiology Unit and Stroke Unit, IRCCS San Martino-IST, Genova, Italy (L. Castellan, L.M.). 14. Interventional Neuroradiology Unit and Stroke Unit, Ospedale Universitario, Parma, Italy (R. Menozzi, U.S.). 15. Interventional Neuroradiology Unit and Stroke Unit, Azienda Ospedaliera-Universitaria, Padova, Italy (F.C., C.B.). 16. Vascular and Interventional Radiology Unit and Neurology Unit, Ospedale Civile Mazzini, Teramo, Italy (E.P., A. Casalena). 17. Neuroradiology Unit and Neurology Unit, Ospedale M. Bufalini, Cesena, Italy (M. Ruggiero, E.M.). 18. Interventional Neuroradiology Unit and Neurology Unit, Ospedale San Giovanni Bosco, Torino, Italy (C.C., G. Chianale). 19. Neuroradiology Unit and Neurology Unit, Ospedale Cisanello, Pisa, Italy (D.L.L., M. Mancuso). 20. Radiology, Diagnostic and Interventional Neuroradiology Unit, Policlinico IRCCS San Matteo, Pavia, Italy (E.L.). 21. Cerebrovascular Department, IRCCS Mondino Foundation, Pavia, Italy (A. Cavallini). 22. Neuroradiology Unit and Neurology Unit, Ospedale dell'Angelo-ULSS3 Serenissima, Mestre, Italy (N.C., A. Critelli). 23. Interventional Neuroradiology Unit and Stroke Unit, Azienda Ospedaliera Universitaria-Policlinico, Bari, Italy (L. Chiumarulo, M. Petruzzelli). 24. Neuroradiology Unit and Neurology Unit, Ospedale Universitario Circolo-ASST Sette Laghi, Varese, Italy (A.G., M.V.). 25. Interventional Neuroradiology Unit and Stroke Unit, Ospedale SS. Annunziata, Taranto, Italy (M.P.G., A.T.). 26. Interventional Neuroradiology Unit and Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy (W.A., A.P.). 27. Interventional Neuroradiology Unit and Stroke Unit, Sapienza University Hospital, Rome, Italy (G.G., E.N., D.T.). 28. Interventional Neuroradiology Unit and Stroke Unit, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy (P.F., S.S.). 29. Neuroradiology Unit and Neurology Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy (M. Pavia, P.I.). 30. Interventional Neuroradiology Unit and Stroke Unit, Humanitas Research Hospital, Rozzano, Italy (N.P.N., M.C.S.). 31. Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy (P.A., M. Russo). 32. Neuroradiology Unit and Neurology Unit, AO SS. Antonio e Biagio e C. Arrigo, Alessandria, Italy (D.F.). 33. Interventional Vascular Unit and Stroke Unit, Ospedale S. Michele-AO Brotzu, Cagliari, Italy (S.C.). 34. Interventional Neuroradiology Unit and Stroke Unit, Ospedale Civico-A.R.N.A.S., Palermo, Italy (G. Craparo, M.M.).
Abstract
BACKGROUND AND PURPOSE: As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA). METHODS: We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. RESULTS: GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0-1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602-1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515-0.990). The rates of modified Rankin Scale score of 0-2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689-1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566-0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644-1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844-1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262-0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337-0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of <1, antiplatelet, and anticoagulant), differences were found also between GA versus CS as regards modified Rankin Scale score of 0-2 (aOR, 0.659 [95% CI, 0.538-0.807]) and GA versus LA as regards death (aOR, 1.413 [95% CI, 1.095-1.823]). CONCLUSIONS: GA during thrombectomy was associated with worse 3-month functional outcomes, especially when compared with LA. The inclusion of an LA arm in future randomized clinical trials of anesthesia strategy is recommended.
BACKGROUND AND PURPOSE: As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in strokepatients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA). METHODS: We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. RESULTS: GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0-1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602-1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515-0.990). The rates of modified Rankin Scale score of 0-2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689-1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566-0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644-1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844-1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262-0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337-0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of <1, antiplatelet, and anticoagulant), differences were found also between GA versus CS as regards modified Rankin Scale score of 0-2 (aOR, 0.659 [95% CI, 0.538-0.807]) and GA versus LA as regards death (aOR, 1.413 [95% CI, 1.095-1.823]). CONCLUSIONS: GA during thrombectomy was associated with worse 3-month functional outcomes, especially when compared with LA. The inclusion of an LA arm in future randomized clinical trials of anesthesia strategy is recommended.
Authors: Jon Equiza; Patricia de la Riva; José Angel Larrea; Juan Marta-Enguita; Inés Albájar; Alex Lüttich; Eñaut Garmendia; Maitane Alonso; Ana de Arce; Noemí Díez; Félix Gonzalez; Pablo Iruzubieta; Naroa Sulibarria; Josep Puig; Maite Martínez-Zabaleta Journal: Eur Stroke J Date: 2022-05-27
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