TY - JOUR
T1 - Type of Anesthesia and Differences in Clinical Outcome After Intra-Arterial Treatment for Ischemic Stroke
AU - van den Berg, Lucie A.
AU - Koelman, Diederik L. H.
AU - Berkhemer, Olvert A.
AU - Rozeman, Anouk D.
AU - Fransen, Puck S. S.
AU - Beumer, Debbie
AU - Dippel, Diederik W.
AU - van der Lugt, Aad
AU - van Oostenbrugge, Robert J.
AU - van Zwam, Wim H.
AU - Brouwer, Patrick A.
AU - Jenniskens, Sjoerd
AU - Boiten, Jelis
AU - Nijeholt, Geert A. Lycklama a
AU - Vos, Jan Albert
AU - Schonewille, Wouter J.
AU - Majoie, Charles B. L. M.
AU - Roos, Yvo B. W. E. M.
PY - 2015/5
Y1 - 2015/5
N2 - Background and Purpose-Intra-arterial treatment (IAT) in patients with acute ischemic stroke (AIS) can be performed with or without general anesthesia (GA). Previous studies suggested that IAT without the use of GA (non-GA) is associated with better clinical outcome. Nevertheless, no consensus exists about the anesthetic management during IAT of AIS patients. This study investigates the association between type of anesthesia and clinical outcome in a large cohort of patients with AIS treated with IAT. Methods-All consecutive patients with AIS of the anterior circulation who received IAT between 2002 and 2013 in 16 Dutch hospitals were included in the study. Primary outcome was functional outcome on the modified Rankin Scale at discharge. Difference in primary outcome between GA and non-GA was estimated using multiple ordinal regression analysis, adjusting for age, stroke severity, occlusion of the internal carotid artery terminus, previous stroke, atrial fibrillation, and diabetes mellitus. Results-Three hundred forty-eight patients were included in the analysis; 70 patients received GA and 278 patients did not receive GA. Non-GA was significantly associated with good clinical outcome (odds ratio 2.1, 95% confidence interval 1.02-4.31). After adjusting for prespecified prognostic factors, the point estimate remained similar; statistical significance, however, was lost (odds ratio 1.9, 95% confidence interval 0.89-4.24). Conclusions-Our study suggests that patients with AIS of the anterior circulation undergoing IAT without GA have a higher probability of good clinical outcome compared with patients treated with general anesthesia.
AB - Background and Purpose-Intra-arterial treatment (IAT) in patients with acute ischemic stroke (AIS) can be performed with or without general anesthesia (GA). Previous studies suggested that IAT without the use of GA (non-GA) is associated with better clinical outcome. Nevertheless, no consensus exists about the anesthetic management during IAT of AIS patients. This study investigates the association between type of anesthesia and clinical outcome in a large cohort of patients with AIS treated with IAT. Methods-All consecutive patients with AIS of the anterior circulation who received IAT between 2002 and 2013 in 16 Dutch hospitals were included in the study. Primary outcome was functional outcome on the modified Rankin Scale at discharge. Difference in primary outcome between GA and non-GA was estimated using multiple ordinal regression analysis, adjusting for age, stroke severity, occlusion of the internal carotid artery terminus, previous stroke, atrial fibrillation, and diabetes mellitus. Results-Three hundred forty-eight patients were included in the analysis; 70 patients received GA and 278 patients did not receive GA. Non-GA was significantly associated with good clinical outcome (odds ratio 2.1, 95% confidence interval 1.02-4.31). After adjusting for prespecified prognostic factors, the point estimate remained similar; statistical significance, however, was lost (odds ratio 1.9, 95% confidence interval 0.89-4.24). Conclusions-Our study suggests that patients with AIS of the anterior circulation undergoing IAT without GA have a higher probability of good clinical outcome compared with patients treated with general anesthesia.
KW - acute stroke
KW - anesthesia
KW - conscious sedation
KW - thrombectomy
KW - thrombolytic therapy
U2 - 10.1161/STROKEAHA.115.008699
DO - 10.1161/STROKEAHA.115.008699
M3 - Article
SN - 0039-2499
VL - 46
SP - 1257
EP - 1262
JO - Stroke
JF - Stroke
IS - 5
ER -