Hypotension during endovascular treatment under general anesthesia for acute ischemic stroke

Sabine L. Collette*, Maarten Uyttenboogaart, Noor Samuels, Irene C. van der Schaaf, H. Bart van der Worp, Gert Jan R. Luijckx, Allart M. Venema, Marko M. Sahinovic, Rudi A. J. O. Dierckx, Hester F. Lingsma, Teus H. Kappen, Reinoud P. H. Bokkers, MR CLEAN Registry Investigators, Diederik W. J. Dippel, Aad van der Lugt, Charles B. L. M. Majoie, Yvo B. W. E. M. Roos, Robert J. van Oostenbrugge, Wim H. van Zwam, Geert J. Lycklama a NijeholtJelis Boiten, Jan Albert Vos, Wouter J. Schonewille, Jeannette Hofmeijer, Jasper M. Martens, Rob H. Lo

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Web of Science)

Abstract

Objective

The effect of anesthetic management (general anesthesia [GA], conscious sedation, or local anesthesia) on functional outcome and the role of blood pressure management during endovascular treatment (EVT) for acute ischemic stroke is under debate. We aimed to determine whether hypotension during EVT under GA is associated with functional outcome at 90 days.

Methods

We retrospectively collected data from patients with a proximal intracranial occlusion of the anterior circulation treated with EVT under GA. The primary outcome was the distribution on the modified Rankin Scale at 90 days. Hypotension was defined using two thresholds: a mean arterial pressure (MAP) of 70 mm Hg and a MAP 30% below baseline MAP. To quantify the extent and duration of hypotension, the area under the threshold (AUT) was calculated using both thresholds.

Results

Of the 366 patients included, procedural hypotension was observed in approximately half of them. The occurrence of hypotension was associated with poor functional outcome (MAP = 30%: acOR, 0.76; 95% CI, 0.48-1.21). In addition, an association was found between the number of hypotensive periods and poor functional outcome (MAP = 30%: acOR, 0.90 per period; 95% CI, 0.78-1.04). No association existed between AUT and functional outcome (MAP = 30%: acOR, 1.000 per 10 mm Hg*min; 95% CI, 0.999-1.000).

Conclusions

Occurrence of procedural hypotension and an increase in number of procedural hypotensive periods were associated with poor functional outcome, whereas the extent and duration of hypotension were not. Randomized clinical trials are needed to confirm our hypothesis that hypotension during EVT under GA has detrimental effects.

Original languageEnglish
Article number0249093
Number of pages16
JournalPLOS ONE
Volume16
Issue number6
DOIs
Publication statusPublished - 23 Jun 2021

Keywords

  • INDIVIDUAL PATIENT DATA
  • CONSCIOUS SEDATION
  • BLOOD-PRESSURE
  • INTRAOPERATIVE HYPOTENSION
  • INTRAARTERIAL TREATMENT
  • THROMBECTOMY
  • MANAGEMENT
  • THERAPY
  • TRIAL
  • OUTCOMES

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