TY - JOUR
T1 - Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN Registry
AU - MR-CLEAN Registry Investigators
AU - Goldhoorn, Robert-Jan B
AU - Bernsen, Marie Louise E
AU - Hofmeijer, Jeannette
AU - Martens, Jasper M
AU - Lingsma, Hester F
AU - Dippel, Diederik W J
AU - van der Lugt, Aad
AU - Buhre, Wolfgang F F A
AU - Roos, Yvo B W E M
AU - Majoie, Charles B L M
AU - Vos, Jan Albert
AU - Boiten, Jelis
AU - Emmer, Bart
AU - van Oostenbrugge, Robert J
AU - van Zwam, Wim H
N1 - © 2019 American Academy of Neurology.
PY - 2020/1/7
Y1 - 2020/1/7
N2 - 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.
AB - 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.
KW - Aged
KW - Aged, 80 and over
KW - Anesthesia, General
KW - Anesthesia, Local
KW - Anesthesia/methods
KW - Brain Ischemia/surgery
KW - Conscious Sedation
KW - Endovascular Procedures/adverse effects
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Netherlands
KW - Postoperative Complications/epidemiology
KW - Prospective Studies
KW - Registries
KW - Stroke/surgery
KW - Treatment Outcome
UR - http://www.scopus.com/inward/record.url?scp=85077478019&partnerID=8YFLogxK
U2 - https://doi.org/10.1212/WNL.0000000000008674
DO - https://doi.org/10.1212/WNL.0000000000008674
M3 - Article
C2 - 31806692
SN - 0028-3878
VL - 94
SP - e97-e106
JO - Neurology
JF - Neurology
IS - 1
ER -