Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN Registry.

Aged Aged, 80 and over Anesthesia / methods Anesthesia, General Anesthesia, Local Brain Ischemia / surgery Conscious Sedation Endovascular Procedures / adverse effects Female Humans Male Middle Aged Netherlands Postoperative Complications / epidemiology Prospective Studies Registries Stroke / surgery Treatment Outcome

Journal

Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060

Informations de publication

Date de publication:
07 01 2020
Historique:
received: 12 12 2018
accepted: 12 07 2019
pubmed: 7 12 2019
medline: 24 3 2020
entrez: 7 12 2019
Statut: ppublish

Résumé

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. 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. 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 cOR 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. This study provides Class III evidence that for patients with acute ischemic stroke undergoing EVT, LA improves functional outcome compared to GA or CS.

Identifiants

DOI: 10.1212/WNL.0000000000008674 PMID: 31806692
pubmed: 31806692
pii: WNL.0000000000008674
doi: 10.1212/WNL.0000000000008674
doi:

Types de publication

Comparative Study Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e97-e106

Investigateurs

Diederik W.J. Dippel (DW)
Aad van der Lugt (A)
Charles B.L.M. Majoie (CB)
Yvo B.W.E.M. Roos Roos (YBR)
Robert J. van Oostenbrugge (RJ)
Wim H. van Zwam (WH)
Jelis Boiten (J)
Jan Albert Vos (JA)
Ivo G.H. Jansen (IG)
Maxim J.H.L. Mulder (MJ)
Robert- Jan B. Goldhoorn (RJB)
Jonathan M. Coutinho (JM)
Marieke J.H. Wermer (MJ)
Marianne A.A. van Walderveen (MAV)
Julie Staals (J)
Jeannette Hofmeijer (J)
Jasper M. Martens (JM)
Geert J. Lycklama à Nijeholt (GJ)
Bob Roozenbeek (B)
Bart J. Emmer (BJ)
Sebastiaan F. de Bruijn (SF)
Lukas C. van Dijk (LC)
H. Bart van der Worp (HB)
Rob H. Lo (RH)
Ewoud J. van Dijk (EJ)
Hieronymus D. Boogaarts (HD)
Paul L.M. de Kort (PL)
Jo J.P. Peluso (JJ)
Jan S.P. van den Berg (JS)
Boudewijn A.A.M. van Hasselt (BA)
Leo A.M. Aerden (LA)
René J. Dallinga (RJ)
Maarten Uyttenboogaart (M)
Omid Eshghi (O)
Tobien H.C.M.L. Schreuder (TH)
Roel J.J. Heijboer (RJ)
Koos Keizer (K)
Lonneke S.F. Yo (LS)
Heleen M. den Hertog (HM)
Emiel J.C. Sturm (EJ)
Marieke E.S. Sprengers (ME)
Sjoerd F.M. Jenniskens (SF)
René van den Berg (R)
Albert J. Yoo (AJ)
Ludo F.M. Beenen (LF)
Stefan D. Roosendaal (SD)
Bas F.W. van der Kallen (BF)
Ido R. van den Wijngaard (IR)
Ad van Es (A)
Joost Bot (J)
Pieter-Jan van Doormaal (PJ)
Alida Postma (A)
H. Zwenneke Flach (HZ)
Hester F. Lingsma (HF)
Rob H. Lo (RH)
Naziha el Ghannouti (N)
Martin Sterrenberg (M)
Corina Puppels (C)
Wilma Pellikaan (W)
Rita Sprengers (R)
Marjan Elfrink (M)
Joke de Meris (J)
Tamara Vermeulen (T)
Annet Geerlings (A)
Gina van Vemde (G)
Tiny Simons (T)
Cathelijn van Rijswijk (C)
Gert Messchendorp (G)
Hester Bongenaar (H)
Karin Bodde (K)
Sandra Kleijn (S)
Hanneke Lodico (H)
Maureen Wollaert (M)
Daisy Jeurrissen (D)
Erna Bos (E)
Yvonne Drabbe (Y)
Berber Zweedijk (B)
Mostafa Khalilzada (M)
Esmee Venema (E)
Vicky Chalos (V)
Kars J. Compagne (KJ)
Ralph R. Geuskens (RR)
Tim van Straaten (T)
Saliha Ergezen (S)
Roger R.M. Harmsma (RRM)
Daan Muijres (D)
Anouk de Jong (A)
Wouter Hinsenveld (W)
Olvert A. Berkhemer (OA)
Anna M.M. Boers (AM)
J Huguet (J)
P F C Groot (PFC)
Marieke A. Mens (MA)
Katinka R. van Kranendonk (KR)
Kilian M. Treurniet (KM)
Manon Kappelhof (M)
Manon L. Tolhuijsen (ML)
Heitor Alves (H)

Informations de copyright

© 2019 American Academy of Neurology.

Auteurs

Robert-Jan B Goldhoorn (RB)

From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands. robertjan.goldhoorn@mumc.nl.

Marie Louise E Bernsen (MLE)

From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands.

Jeannette Hofmeijer (J)

From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands.

Jasper M Martens (JM)

From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands.

Hester F Lingsma (HF)

From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands.

Diederik W J Dippel (DWJ)

From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands.

Aad van der Lugt (A)

From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands.

Wolfgang F F A Buhre (WFFA)

From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands.

Yvo B W E M Roos (YBWEM)

From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands.

Charles B L M Majoie (CBLM)

From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands.

Jan Albert Vos (JA)

From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands.

Jelis Boiten (J)

From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands.

Bart Emmer (B)

From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands.

Robert J van Oostenbrugge (RJ)

From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands.

Wim H van Zwam (WH)

From the Departments of Neurology (R.-J.B.G., R.J.v.O.), Anesthesiology (W.F.F.A.B.), and Radiology (W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center; Departments of Radiology (M.L.E.B., J.M.M.) and Neurology (J.H.), Rijnstate Hospital, Arnhem; Departments of Public Health (H.F.L.), Neurology (D.W.J.D.), and Radiology (A.v.d.L., B.E.), Erasmus MC, University Medical Center, Rotterdam; Departments of Neurology (Y.B.W.E.M.R.) and Radiology and Nuclear Medicine (C.B.L.M.M., B.E.), Academic Medical Center, Amsterdam; Department of Radiology (J.A.V.), Sint Antonius Hospital, Nieuwegein; and Department of Neurology (J.B.), Haaglanden Medical Center, The Hague, the Netherlands.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Anesthetic management during endovascular...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Anesthetic management during endovascular...
questionsmedicales.fr › Anesthésie et analgésie › Anesthésie › Anesthetic management during endovascular...
questionsmedicales.fr › Anesthésie et analgésie › Anesthésie › Anesthésie générale › Anesthetic management during endovascular...
questionsmedicales.fr › Anesthésie et analgésie › Anesthésie › Anesthésie de conduction › Anesthésie locale › Anesthetic management during endovascular...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Encéphalopathie ischémique › Anesthetic management during endovascular...
questionsmedicales.fr › Anesthésie et analgésie › Sédation consciente › Anesthetic management during endovascular...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Procédures endovasculaires › Anesthetic management during endovascular...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Anesthetic management during endovascular...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Anesthetic management during endovascular...
questionsmedicales.fr › Régions géographiques › Europe › Pays-Bas › Anesthetic management during endovascular...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Anesthetic management during endovascular...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Anesthetic management during endovascular...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enregistrements › Anesthetic management during endovascular...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Anesthetic management during endovascular...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Anesthetic management during endovascular...