General Anesthesia Versus Conscious Sedation and Local Anesthesia During Thrombectomy for Acute Ischemic Stroke.

Aged Aged, 80 and over Anesthesia, General / adverse effects Brain Ischemia / therapy Endovascular Procedures / methods Female Humans Ischemia / therapy Male Middle Aged Registries Stroke / therapy Thrombectomy / methods
anesthesia conscious sedation groin odds ratio thrombectomy

Journal

Stroke
ISSN: 1524-4628
Titre abrégé: Stroke
Pays: United States
ID NLM: 0235266

Informations de publication

Date de publication:
07 2020
Historique:
pubmed: 11 6 2020
medline: 4 11 2020
entrez: 11 6 2020
Statut: ppublish

Résumé

As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA). We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0-1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602-1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515-0.990). The rates of modified Rankin Scale score of 0-2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689-1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566-0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644-1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844-1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262-0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337-0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of <1, antiplatelet, and anticoagulant), differences were found also between GA versus CS as regards modified Rankin Scale score of 0-2 (aOR, 0.659 [95% CI, 0.538-0.807]) and GA versus LA as regards death (aOR, 1.413 [95% CI, 1.095-1.823]). GA during thrombectomy was associated with worse 3-month functional outcomes, especially when compared with LA. The inclusion of an LA arm in future randomized clinical trials of anesthesia strategy is recommended.

Sections du résumé

BACKGROUND AND PURPOSE
As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA).
METHODS
We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke.
RESULTS
GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0-1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602-1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515-0.990). The rates of modified Rankin Scale score of 0-2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689-1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566-0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644-1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844-1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262-0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337-0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of <1, antiplatelet, and anticoagulant), differences were found also between GA versus CS as regards modified Rankin Scale score of 0-2 (aOR, 0.659 [95% CI, 0.538-0.807]) and GA versus LA as regards death (aOR, 1.413 [95% CI, 1.095-1.823]).
CONCLUSIONS
GA during thrombectomy was associated with worse 3-month functional outcomes, especially when compared with LA. The inclusion of an LA arm in future randomized clinical trials of anesthesia strategy is recommended.

Identifiants

DOI: 10.1161/STROKEAHA.120.028963 PMID: 32517584
pubmed: 32517584
doi: 10.1161/STROKEAHA.120.028963
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

2036-2044

Commentaires et corrections

Type : CommentIn
Type : CommentIn

Auteurs

Manuel Cappellari (M)

Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., S.F., E.F.M.C., B.B.).

Giovanni Pracucci (G)

NEUROFARBA Department, University of Florence, Firenze, Italy (G.P., D.I.).

Stefano Forlivesi (S)

Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., S.F., E.F.M.C., B.B.).

Valentina Saia (V)

Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy (V.S., L.A., T.T.).

Sergio Nappini (S)

NEUROFARBA Department, Careggi University Hospital, Firenze, Italy (S.N., P.N., S.M.).

Patrizia Nencini (P)

NEUROFARBA Department, Careggi University Hospital, Firenze, Italy (S.N., P.N., S.M.).

Domenico Inzitari (D)

NEUROFARBA Department, University of Florence, Firenze, Italy (G.P., D.I.).

Laura Greco (L)

Interventional Neuroradiology Unit and Stroke Unit, Policlinico Tor Vergata, Rome, Italy (L.G., F.S.).

Fabrizio Sallustio (F)

Interventional Neuroradiology Unit and Stroke Unit, Policlinico Tor Vergata, Rome, Italy (L.G., F.S.).

Stefano Vallone (S)

Interventional Neuroradiology Unit and Stroke Unit, Ospedale Civile S. Agostino-Estense-University Hospital, Modena, Italy (S.V., G.B.).

Guido Bigliardi (G)

Interventional Neuroradiology Unit and Stroke Unit, Ospedale Civile S. Agostino-Estense-University Hospital, Modena, Italy (S.V., G.B.).

Andrea Zini (A)

Department of Neurology and Stroke Center, IRCCS Institute of the Neurological Sciences, Maggiore Hospital, Bologna, Italy (A.Z., L.S.).

Antonio Pitrone (A)

Interventional Neuroradiology Unit and Stroke Unit, Policlinico G. Martino, Messina, Italy (A. Pitrone, F.G., R. Musolino).

Francesco Grillo (F)

Interventional Neuroradiology Unit and Stroke Unit, Policlinico G. Martino, Messina, Italy (A. Pitrone, F.G., R. Musolino).

Rosa Musolino (R)

Interventional Neuroradiology Unit and Stroke Unit, Policlinico G. Martino, Messina, Italy (A. Pitrone, F.G., R. Musolino).

Sandra Bracco (S)

Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy (S.B., R. Tinturini, R. Tassi).

Rebecca Tinturini (R)

Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy (S.B., R. Tinturini, R. Tassi).

Rossana Tassi (R)

Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy (S.B., R. Tinturini, R. Tassi).

Mauro Bergui (M)

Interventional Neuroradiology Unit and Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy (M.B., P.C.).

Paolo Cerrato (P)

Interventional Neuroradiology Unit and Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy (M.B., P.C.).

Andrea Saletti (A)

Neuroradiology Unit and Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy (A.S., A.D.V., I.C.).

Alessandro De Vito (A)

Neuroradiology Unit and Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy (A.S., A.D.V., I.C.).

Ilaria Casetta (I)

Neuroradiology Unit and Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy (A.S., A.D.V., I.C.).

Roberto Gasparotti (R)

Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy (R.G., M. Magoni).

Mauro Magoni (M)

Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy (R.G., M. Magoni).

Lucio Castellan (L)

Interventional Neuroradiology Unit and Stroke Unit, IRCCS San Martino-IST, Genova, Italy (L. Castellan, L.M.).

Laura Malfatto (L)

Interventional Neuroradiology Unit and Stroke Unit, IRCCS San Martino-IST, Genova, Italy (L. Castellan, L.M.).

Roberto Menozzi (R)

Interventional Neuroradiology Unit and Stroke Unit, Ospedale Universitario, Parma, Italy (R. Menozzi, U.S.).

Umberto Scoditti (U)

Interventional Neuroradiology Unit and Stroke Unit, Ospedale Universitario, Parma, Italy (R. Menozzi, U.S.).

Francesco Causin (F)

Interventional Neuroradiology Unit and Stroke Unit, Azienda Ospedaliera-Universitaria, Padova, Italy (F.C., C.B.).

Claudio Baracchini (C)

Interventional Neuroradiology Unit and Stroke Unit, Azienda Ospedaliera-Universitaria, Padova, Italy (F.C., C.B.).

Edoardo Puglielli (E)

Vascular and Interventional Radiology Unit and Neurology Unit, Ospedale Civile Mazzini, Teramo, Italy (E.P., A. Casalena).

Alfonsina Casalena (A)

Vascular and Interventional Radiology Unit and Neurology Unit, Ospedale Civile Mazzini, Teramo, Italy (E.P., A. Casalena).

Maria Ruggiero (M)

Neuroradiology Unit and Neurology Unit, Ospedale M. Bufalini, Cesena, Italy (M. Ruggiero, E.M.).

Emanuele Malatesta (E)

Neuroradiology Unit and Neurology Unit, Ospedale M. Bufalini, Cesena, Italy (M. Ruggiero, E.M.).

Chiara Comelli (C)

Interventional Neuroradiology Unit and Neurology Unit, Ospedale San Giovanni Bosco, Torino, Italy (C.C., G. Chianale).

Gigliola Chianale (G)

Interventional Neuroradiology Unit and Neurology Unit, Ospedale San Giovanni Bosco, Torino, Italy (C.C., G. Chianale).

Dario Luca Lauretti (DL)

Neuroradiology Unit and Neurology Unit, Ospedale Cisanello, Pisa, Italy (D.L.L., M. Mancuso).

Michelangelo Mancuso (M)

Neuroradiology Unit and Neurology Unit, Ospedale Cisanello, Pisa, Italy (D.L.L., M. Mancuso).

Elvis Lafe (E)

Radiology, Diagnostic and Interventional Neuroradiology Unit, Policlinico IRCCS San Matteo, Pavia, Italy (E.L.).

Anna Cavallini (A)

Cerebrovascular Department, IRCCS Mondino Foundation, Pavia, Italy (A. Cavallini).

Nicola Cavasin (N)

Neuroradiology Unit and Neurology Unit, Ospedale dell'Angelo-ULSS3 Serenissima, Mestre, Italy (N.C., A. Critelli).

Adriana Critelli (A)

Neuroradiology Unit and Neurology Unit, Ospedale dell'Angelo-ULSS3 Serenissima, Mestre, Italy (N.C., A. Critelli).

Elisa Francesca Maria Ciceri (EFM)

Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., S.F., E.F.M.C., B.B.).

Bruno Bonetti (B)

Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., S.F., E.F.M.C., B.B.).

Luigi Chiumarulo (L)

Interventional Neuroradiology Unit and Stroke Unit, Azienda Ospedaliera Universitaria-Policlinico, Bari, Italy (L. Chiumarulo, M. Petruzzelli).

Marco Petruzzelli (M)

Interventional Neuroradiology Unit and Stroke Unit, Azienda Ospedaliera Universitaria-Policlinico, Bari, Italy (L. Chiumarulo, M. Petruzzelli).

Andrea Giorgianni (A)

Neuroradiology Unit and Neurology Unit, Ospedale Universitario Circolo-ASST Sette Laghi, Varese, Italy (A.G., M.V.).

Maurizio Versino (M)

Neuroradiology Unit and Neurology Unit, Ospedale Universitario Circolo-ASST Sette Laghi, Varese, Italy (A.G., M.V.).

Maria Porzia Ganimede (MP)

Interventional Neuroradiology Unit and Stroke Unit, Ospedale SS. Annunziata, Taranto, Italy (M.P.G., A.T.).

Angelica Tinelli (A)

Interventional Neuroradiology Unit and Stroke Unit, Ospedale SS. Annunziata, Taranto, Italy (M.P.G., A.T.).

Wiliam Auteri (W)

Interventional Neuroradiology Unit and Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy (W.A., A.P.).

Alfredo Petrone (A)

Interventional Neuroradiology Unit and Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy (W.A., A.P.).

Giulio Guidetti (G)

Interventional Neuroradiology Unit and Stroke Unit, Sapienza University Hospital, Rome, Italy (G.G., E.N., D.T.).

Ettore Nicolini (E)

Interventional Neuroradiology Unit and Stroke Unit, Sapienza University Hospital, Rome, Italy (G.G., E.N., D.T.).

Luca Allegretti (L)

Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy (V.S., L.A., T.T.).

Tiziana Tassinari (T)

Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy (V.S., L.A., T.T.).

Pietro Filauri (P)

Interventional Neuroradiology Unit and Stroke Unit, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy (P.F., S.S.).

Simona Sacco (S)

Interventional Neuroradiology Unit and Stroke Unit, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy (P.F., S.S.).

Marco Pavia (M)

Neuroradiology Unit and Neurology Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy (M. Pavia, P.I.).

Paolo Invernizzi (P)

Neuroradiology Unit and Neurology Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy (M. Pavia, P.I.).

Nunzio Paolo Nuzzi (NP)

Interventional Neuroradiology Unit and Stroke Unit, Humanitas Research Hospital, Rozzano, Italy (N.P.N., M.C.S.).

Maria Carmela Spinelli (M)

Interventional Neuroradiology Unit and Stroke Unit, Humanitas Research Hospital, Rozzano, Italy (N.P.N., M.C.S.).

Pietro Amistà (P)

Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy (P.A., M. Russo).

Monia Russo (M)

Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy (P.A., M. Russo).

Delfina Ferrandi (D)

Neuroradiology Unit and Neurology Unit, AO SS. Antonio e Biagio e C. Arrigo, Alessandria, Italy (D.F.).

Simona Corraine (S)

Interventional Vascular Unit and Stroke Unit, Ospedale S. Michele-AO Brotzu, Cagliari, Italy (S.C.).

Giuseppe Craparo (G)

Interventional Neuroradiology Unit and Stroke Unit, Ospedale Civico-A.R.N.A.S., Palermo, Italy (G. Craparo, M.M.).

Marina Mannino (M)

Interventional Neuroradiology Unit and Stroke Unit, Ospedale Civico-A.R.N.A.S., Palermo, Italy (G. Craparo, M.M.).

Luigi Simonetti (L)

Department of Neurology and Stroke Center, IRCCS Institute of the Neurological Sciences, Maggiore Hospital, Bologna, Italy (A.Z., L.S.).

Danilo Toni (D)

Interventional Neuroradiology Unit and Stroke Unit, Sapienza University Hospital, Rome, Italy (G.G., E.N., D.T.).

Salvatore Mangiafico (S)

NEUROFARBA Department, Careggi University Hospital, Firenze, Italy (S.N., P.N., S.M.).

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › General Anesthesia Versus Conscious Sedation...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › General Anesthesia Versus Conscious Sedation...
questionsmedicales.fr › Anesthésie et analgésie › Anesthésie › Anesthésie générale › General Anesthesia Versus Conscious Sedation...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Encéphalopathie ischémique › General Anesthesia Versus Conscious Sedation...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Procédures endovasculaires › General Anesthesia Versus Conscious Sedation...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › General Anesthesia Versus Conscious Sedation...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Ischémie › General Anesthesia Versus Conscious Sedation...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › General Anesthesia Versus Conscious Sedation...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enregistrements › General Anesthesia Versus Conscious Sedation...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › General Anesthesia Versus Conscious Sedation...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie cardiovasculaire › Procédures de chirurgie vasculaire › Thrombectomie › General Anesthesia Versus Conscious Sedation...