Impact of Anesthesia on the Outcome of Acute Ischemic Stroke after Endovascular Treatment with the Solitaire Stent Retriever.

Abstract

BACKGROUND AND PURPOSE:

General anesthesia during endovascular treatment of acute ischemic stroke may have an adverse effect on outcome compared with conscious sedation. The aim of this study was to examine the impact of the type of anesthesia on the outcome of patients with acute ischemic stroke treated with the Solitaire stent retriever, accounting for confounding factors.

MATERIALS AND METHODS:

Four-hundred one patients with consecutive acute anterior circulation stroke treated with a Solitaire stent retriever were included in this prospective analysis. Outcome was assessed after 3 months by the modified Rankin Scale.

RESULTS:

One-hundred thirty-five patients (31%) underwent endovascular treatment with conscious sedation, and 266 patients (69%), with general anesthesia. Patients under general anesthesia had higher NIHSS scores on admission (17 versus 13, P < .001) and more internal carotid artery occlusions (44.6% versus 14.8%, P < .001) than patients under conscious sedation. Other baseline characteristics such as time from symptom onset to the start of endovascular treatment did not differ. Favorable outcome (mRS 0-2) was more frequent with conscious sedation (47.4% versus 32%; OR, 0.773; 95% CI, 0.646-0.925; P = .002) in univariable but not multivariable logistic regression analysis (P = .629). Mortality did not differ (P = .077). Independent predictors of outcome were age (OR, 0.95; 95% CI, 0.933-0.969; P < .001), NIHSS score (OR, 0.894; 95% CI, 0.855-0.933; P < .001), time from symptom onset to the start of endovascular treatment (OR, 0.998; 95% CI, 0.996-0.999; P = .011), diabetes mellitus (OR, 0.544; 95% CI, 0.305-0.927; P = .04), and symptomatic intracerebral hemorrhage (OR, 0.109; 95% CI, 0.028-0.428; P = .002).

CONCLUSIONS:

In this single-center study, the anesthetic management during stent retriever thrombectomy with general anesthesia or conscious sedation had no impact on the outcome of patients with large-vessel occlusion in the anterior circulation.

• Authors: A Slezak, R Kurmann, L Oppliger, A Broeg-Morvay, J Gralla, G Schroth, H P Mattle, M Arnold, U Fischer, S Jung, R Greif, F Neff, P Mordasini, M-L Mono
• Journal: AJNR. American journal of neuroradiology (AJNR Am J Neuroradiol) Vol. 38 Issue 7 Pg. 1362-1367 (Jul 2017) ISSN: 1936-959X [Electronic] United States
• PMID: 28473340 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2017 by American Journal of Neuroradiology.

Topics

• Aged
• Aged, 80 and over
• Anesthesia, General
• Brain Ischemia (surgery)
• Conscious Sedation
• Device Removal (adverse effects, methods)
• Endovascular Procedures (methods)
• Female
• Humans
• Intraoperative Complications (epidemiology)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Postoperative Complications (epidemiology)
• Prospective Studies
• Stents
• Stroke (surgery)
• Thrombectomy (adverse effects)
• Tomography, X-Ray Computed
• Treatment Outcome