TY - JOUR
T1 - Conscious sedation or local anesthesia during endovascular treatment for acute ischemic stroke
AU - van de Graaf, Rob A
AU - Samuels, Noor
AU - Mulder, Maxim J H L
AU - Eralp, Ismail
AU - van Es, Adriaan C G M
AU - Dippel, Diederik W J
AU - van der Lugt, Aad
AU - Emmer, Bart J
AU - MR CLEAN Registry Investigators
AU - Bot, JCJ
AU - Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry Investigators
AU - Majoie, Charles B. L. M.
AU - Roos, Yvo B. W. E. M.
AU - van Oostenbrugge, Robert J.
AU - van Zwam, Wim H.
AU - Boiten, Jelis
AU - Vos, Jan Albert
AU - Jansen, Ivo G. H.
AU - Goldhoorn, Robert-Jan B.
AU - Schonewille, Wouter J.
AU - Vos, Jan Albert
AU - Majoie, Charles B. L. M.
AU - Coutinho, Jonathan M.
AU - Wermer, Marieke J. H.
AU - van Walderveen, Marianne A. A.
AU - Staals, Julie
AU - van Zwam, Wim H.
AU - Hofmeijer, Jeannette
AU - Martens, Jasper M.
AU - Lycklama À Nijeholt, Geert J.
AU - Boiten, Jelis
AU - Roozenbeek, Bob
AU - de Bruijn, Sebastiaan F.
AU - van Dijk, Lukas C.
AU - van der Worp, H. Bart
AU - Majoie, Charles B. L. M.
AU - Sprengers, Marieke E. S.
AU - van den Berg, René
AU - Beenen, Ludo F. M.
AU - Roosendaal, Stefan D.
AU - Majoie, Charles B. L. M.
AU - Roos, Yvo B. W. E. M.
AU - Berkhemer, Olvert A.
AU - Boers, Anna M. M.
AU - van Kranendonk, Katinka R.
AU - Treurniet, Kilian M.
AU - Kappelhof, Manon
PY - 2018/7/3
Y1 - 2018/7/3
N2 - OBJECTIVE: To investigate the effect of conscious sedation (CS) on functional outcome and complication rates after intra-arterial treatment (IAT) for acute ischemic stroke (AIS) compared to the use of local anesthesia (LA) at the puncture site only.METHODS: Patients undergoing IAT for AIS with CS or LA in the Erasmus University Medical Center from March 2014 to June 2016 were included for analysis. The primary outcome was the score on the ordinal modified Rankin Scale (mRS). We compared CS to LA by ordinal logistic regression with covariate adjustment using propensity scoring.RESULTS: In 146 AIS patients treated with IAT, use of CS was associated with a shift towards worse mRS scores (odds ratio [OR] 0.4 [95% confidence interval (CI) 0.2-0.7]) compared to LA. Mortality after 90 days was higher in the CS group compared to the LA group (OR 2.3 [95% CI 1.0-5.2]). No differences between groups were noted with regard to procedure duration (8 minutes, β = 6.3 [95% CI -7.4 to 20.0]) or occurrence of procedure-related complications (OR 1.3 [95% CI 0.6-2.7]).CONCLUSION: CS was associated with poor functional outcome and increased mortality rates compared to LA. Furthermore, CS did not reduce duration of intervention or interventional complications. CS during IAT for AIS is of no benefit if LA is considered safe.CLASSIFICATION OF EVIDENCE: This study provides Class II evidence, because of nonrandom allocation, that for patients with AIS undergoing IAT, LA rather than CS improves functional outcome.
AB - OBJECTIVE: To investigate the effect of conscious sedation (CS) on functional outcome and complication rates after intra-arterial treatment (IAT) for acute ischemic stroke (AIS) compared to the use of local anesthesia (LA) at the puncture site only.METHODS: Patients undergoing IAT for AIS with CS or LA in the Erasmus University Medical Center from March 2014 to June 2016 were included for analysis. The primary outcome was the score on the ordinal modified Rankin Scale (mRS). We compared CS to LA by ordinal logistic regression with covariate adjustment using propensity scoring.RESULTS: In 146 AIS patients treated with IAT, use of CS was associated with a shift towards worse mRS scores (odds ratio [OR] 0.4 [95% confidence interval (CI) 0.2-0.7]) compared to LA. Mortality after 90 days was higher in the CS group compared to the LA group (OR 2.3 [95% CI 1.0-5.2]). No differences between groups were noted with regard to procedure duration (8 minutes, β = 6.3 [95% CI -7.4 to 20.0]) or occurrence of procedure-related complications (OR 1.3 [95% CI 0.6-2.7]).CONCLUSION: CS was associated with poor functional outcome and increased mortality rates compared to LA. Furthermore, CS did not reduce duration of intervention or interventional complications. CS during IAT for AIS is of no benefit if LA is considered safe.CLASSIFICATION OF EVIDENCE: This study provides Class II evidence, because of nonrandom allocation, that for patients with AIS undergoing IAT, LA rather than CS improves functional outcome.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85059109188&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29858471
U2 - https://doi.org/10.1212/WNL.0000000000005732
DO - https://doi.org/10.1212/WNL.0000000000005732
M3 - Article
C2 - 29858471
SN - 0028-3878
VL - 91
SP - e19-e25
JO - Neurology
JF - Neurology
IS - 1
ER -