TY - JOUR
T1 - The effect of anesthetic management during intra-arterial therapy for acute stroke in MR CLEAN
AU - Berkhemer, Olvert A.
AU - van den Berg, Lucie A.
AU - Fransen, Puck S. S.
AU - Beumer, Debbie
AU - Yoo, Albert J.
AU - Lingsma, Hester F.
AU - Schonewille, Wouter J.
AU - van den Berg, Rene
AU - Wermer, Marieke J. H.
AU - Boiten, Jelis
AU - Nijeholt, Geert J. Lycklama
AU - Nederkoorn, Paul J.
AU - Hollmann, Markus W.
AU - van Zwam, Wim H.
AU - van der Lugt, Aad
AU - van Oostenbrugge, Robert J.
AU - Majoie, Charles B. L. M.
AU - Dippel, Diederik W. J.
AU - Roos, Yvo B. W. E. M.
PY - 2016/8/16
Y1 - 2016/8/16
N2 - Background: The aim of the current study was to assess the influence of anesthetic management on the effect of treatment in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN). Methods: MR CLEAN was amulticenter, randomized, open-label trial of intra-arterial therapy (IAT) vs no IAT. The intended anesthetic management at the start of the procedure was used for this post hoc analysis. The primary effect parameter was the adjusted common odds ratio (acOR) for a shift in direction of a better outcome on the modified Rankin Scale (mRS) at 90 days, estimated with multivariable ordinal logistic regression analysis, which included a term for general anesthesia (GA). Results: GA was associated with significant (p=0.011) effect modification, resulting in estimated decrease of 51%(95% confidence interval [CI] 31%-86%) in treatment effect compared to non-GA. We found a shift in the distribution on the mRS in favor of non-GA compared to control group (acOR 2.18 [95% CI 1.49-3.20]). The shift in distribution between GA and control group was in a similar direction (acOR 1.12 [95% CI 0.71-1.78]) with loss of statistical significance. Conclusions: In this post hoc analysis, we found that the type of anesthetic management influences outcome following IAT. Only treatment without general anesthesia was associated with a significant treatment benefit in MR CLEAN. Classification of evidence: This study provides Class II evidence that for patients with acute ischemic stroke undergoing IAT, mRS scores at 90 days improve only in patients treated without GA.
AB - Background: The aim of the current study was to assess the influence of anesthetic management on the effect of treatment in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN). Methods: MR CLEAN was amulticenter, randomized, open-label trial of intra-arterial therapy (IAT) vs no IAT. The intended anesthetic management at the start of the procedure was used for this post hoc analysis. The primary effect parameter was the adjusted common odds ratio (acOR) for a shift in direction of a better outcome on the modified Rankin Scale (mRS) at 90 days, estimated with multivariable ordinal logistic regression analysis, which included a term for general anesthesia (GA). Results: GA was associated with significant (p=0.011) effect modification, resulting in estimated decrease of 51%(95% confidence interval [CI] 31%-86%) in treatment effect compared to non-GA. We found a shift in the distribution on the mRS in favor of non-GA compared to control group (acOR 2.18 [95% CI 1.49-3.20]). The shift in distribution between GA and control group was in a similar direction (acOR 1.12 [95% CI 0.71-1.78]) with loss of statistical significance. Conclusions: In this post hoc analysis, we found that the type of anesthetic management influences outcome following IAT. Only treatment without general anesthesia was associated with a significant treatment benefit in MR CLEAN. Classification of evidence: This study provides Class II evidence that for patients with acute ischemic stroke undergoing IAT, mRS scores at 90 days improve only in patients treated without GA.
U2 - 10.1212/WNL.0000000000002976
DO - 10.1212/WNL.0000000000002976
M3 - Article
C2 - 27421546
SN - 0028-3878
VL - 87
SP - 656
EP - 664
JO - Neurology
JF - Neurology
IS - 7
ER -