The Functional Prognosis of Rescue Conscious Sedation During Mechanical Thrombectomy on Patients with Acute Anterior Circulation Ischemic Stroke: A Single-Center Retrospective Study.
Acute anterior circulation ischemic stroke
Local anesthesia
Mechanical thrombectomy
Poststroke pneumonia
Rescue conscious sedation
Journal
Neurology and therapy
ISSN: 2193-8253
Titre abrégé: Neurol Ther
Pays: New Zealand
ID NLM: 101637818
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
18
05
2023
accepted:
20
07
2023
medline:
2
8
2023
pubmed:
2
8
2023
entrez:
2
8
2023
Statut:
ppublish
Résumé
Based on real-world case data, this study intends to explore and analyze the impact of rescue conscious sedation (CS) on the clinical outcomes of patients with anterior circulation acute ischemic stroke (AIS) receiving mechanical thrombectomy (MT). This retrospective study enrolled patients with anterior circulation AIS who received MT and were treated with either single local anesthesia (LA) or rescue CS during MT between January 2018 and October 2021. We used univariate and multivariate logistic regression methods to compare the impact of LA and CS on the clinical outcomes of patients with AIS who received MT, including the mRS at 90 days, the incidence of poststroke pneumonia (PSP), the incidence of symptomatic intracranial cerebral hemorrhage (sICH), and the mortality rate. We reviewed 314 patient cases with AIS who received MT. Of all patients, 164 met our search criteria. Eighty-nine patients received LA, and 75 patients received rescue CS. There was no significant difference between the two groups in the 90-day good prognosis (45.3% vs. 51.7%, p = 0.418) and mortality (17.3% vs. 22.5%, p = 0.414). Compared with the LA group, the incidence of postoperative pneumonia in the rescue CS group (44% vs. 25.8%, p = 0.015) was more significant. Multivariate stepwise logistic regression analysis revealed that intraoperative remedial CS was independently associated with PSP following MT. In a subgroup analysis, rescue CS was found to significantly increase the incidence of PSP in patients with dysphagia (OR = 7.307, 95% CI 2.144-24.906, p = 0.001). As the severity of the National Institutes of Health Stroke Scale (NIHSS) increased, intraoperative rescue CS was found to increase the risk of PSP (OR = 1.155, 95% CI 1.034-1.290, p = 0.011) by 5.1% compared to that of LA (OR = 1.104, 95% CI 1.013-1.204, p = 0.024). Compared to LA, rescue CS during MT does not significantly improve the 90 days of good prognosis and reduce the incidence of sICH and mortality in patients with anterior circulation AIS. However, it has a significantly increased risk of poststroke pneumonia (PSP), particularly in patients with dysphagia.
Identifiants
pubmed: 37531028
doi: 10.1007/s40120-023-00528-y
pii: 10.1007/s40120-023-00528-y
pmc: PMC10444930
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1777-1789Subventions
Organisme : Xi'an Science and Technology Planning Project
ID : 21YXYJ0004
Organisme : Xi'an Science and Technology Planning Project
ID : 21YXYJ0052
Organisme : Xi'an Science and Technology Planning Project
ID : 21YXYJ0035
Organisme : Natural Science Basic Research Project of Shaanxi Province
ID : 2022JM-452
Informations de copyright
© 2023. The Author(s).
Références
Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, Yan B, Dowling RJ, Parsons MW, Oxley TJ, Wu TY, Brooks M, Simpson MA, Miteff F, Levi CR, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Priglinger M, Ang T, Scroop R, Barber PA, McGuinness B, Wijeratne T, Phan TG, Chong W, Chandra RV, Bladin CF, Badve M, Rice H, de Villiers L, Ma H, Desmond PM, Donnan GA, Davis SM, EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–18.
doi: 10.1056/NEJMoa1414792
pubmed: 25671797
Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, San Román L, Serena J, Abilleira S, Ribó M, Millán M, Urra X, Cardona P, López-Cancio E, Tomasello A, Castaño C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Pérez M, Goyal M, Demchuk AM, von Kummer R, Gallofré M, Dávalos A, REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–306.
doi: 10.1056/NEJMoa1503780
pubmed: 25882510
Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, van Walderveen MA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama-à-Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Majoie CB, Dippel DW, MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11–20.
doi: 10.1056/NEJMoa1411587
pubmed: 25517348
Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, du Mesnil de Rochemont R, Singer OC, Jahan R, SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs t-PA alone in stroke. N Engl J Med. 2015;372(24):2285–95.
doi: 10.1056/NEJMoa1415061
pubmed: 25882376
Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn SI, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD, ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30.
doi: 10.1056/NEJMoa1414905
pubmed: 25671798
Brinjikji W, Pasternak J, Murad MH, Cloft HJ, Welch TL, Kallmes DF, Rabinstein AA. Anesthesia-related outcomes for endovascular stroke revascularization: a systematic review and meta-analysis. Stroke. 2017;48(10):2784–91.
doi: 10.1161/STROKEAHA.117.017786
pubmed: 28904228
Campbell BCV, van Zwam WH, Goyal M, Menon BK, Dippel DWJ, Demchuk AM, Bracard S, White P, Dávalos A, Majoie CBLM, van der Lugt A, Ford GA, de la Ossa NP, Kelly M, Bourcier R, Donnan GA, Roos YBWEM, Bang OY, Nogueira RG, Devlin TG, van den Berg LA, Clarençon F, Burns P, Carpenter J, Berkhemer OA, Yavagal DR, Pereira VM, Ducrocq X, Dixit A, Quesada H, Epstein J, Davis SM, Jansen O, Rubiera M, Urra X, Micard E, Lingsma HF, Naggara O, Brown S, Guillemin F, Muir KW, van Oostenbrugge RJ, Saver JL, Jovin TG, Hill MD, Mitchell PJ, HERMES Collaborators. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol. 2018;17(1):47–53.
doi: 10.1016/S1474-4422(17)30407-6
pubmed: 29263006
Han H, Wang Y, Wang H, Sun H, Wang X, Gong J, Huo X, Zhu Q, Che F. General anesthesia vs local anesthesia during endovascular treatment for acute large vessel occlusion: a propensity score-matched analysis. Front Neurol. 2022;12:801024.
doi: 10.3389/fneur.2021.801024
pubmed: 35237222
pmcid: 8884159
Schönenberger S, Uhlmann L, Hacke W, Schieber S, Mundiyanapurath S, Purrucker JC, Nagel S, Klose C, Pfaff J, Bendszus M, Ringleb PA, Kieser M, Möhlenbruch MA, Bösel J. Effect of conscious sedation vs general anesthesia on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy: a randomized clinical trial. JAMA. 2016;316(19):1986–96.
doi: 10.1001/jama.2016.16623
pubmed: 27785516
Simonsen CZ, Yoo AJ, Sørensen LH, Juul N, Johnsen SP, Andersen G, Rasmussen M. Effect of general anesthesia and conscious sedation during endovascular therapy on infarct growth and clinical outcomes in acute ischemic stroke: a randomized clinical trial. JAMA Neurol. 2018;75(4):470–7.
doi: 10.1001/jamaneurol.2017.4474
pubmed: 29340574
pmcid: 5885172
LöwhagenHendén P, Rentzos A, Karlsson JE, Rosengren L, Leiram B, Sundeman H, Dunker D, Schnabel K, Wikholm G, Hellström M, Ricksten SE. General anesthesia versus conscious sedation for endovascular treatment of acute ischemic stroke: the AnStroke Trial (Anesthesia During Stroke). Stroke. 2017;48(6):1601–7.
doi: 10.1161/STROKEAHA.117.016554
Goldhoorn RB, Bernsen MLE, Hofmeijer J, Martens JM, Lingsma HF, Dippel DWJ, van der Lugt A, Buhre WFFA, Roos YBWEM, Majoie CBLM, Vos JA, Boiten J, Emmer B, van Oostenbrugge RJ, van Zwam WH. Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN Registry. Neurology. 2020;94(1):97–106.
doi: 10.1212/WNL.0000000000008674
Benvegnù F, Richard S, Marnat G, Bourcier R, Labreuche J, Anadani M, Sibon I, Dargazanli C, Arquizan C, Anxionnat R, Audibert G, Zhu F, Mazighi M, Blanc R, Lapergue B, Consoli A, Gory B, ETIS Registry Investigators. Local anesthesia without sedation during thrombectomy for anterior circulation stroke is associated with worse outcome. Stroke. 2020;51(10):2951–9.
doi: 10.1161/STROKEAHA.120.029194
pubmed: 32895016
Shen H, Ma X, Wu Z, Shao X, Cui J, Zhang B, Abdelrahim ME, Zhang J. Conscious sedation compared to general anesthesia for intracranial mechanical thrombectomy: a meta-analysis. Brain Behav. 2021;11(6): e02161.
doi: 10.1002/brb3.2161
pubmed: 33960706
pmcid: 8213640
Butt W, Dhillon PS, Podlasek A, Malik L, Nair S, Hewson D, England TJ, Lenthall R, McConachie N. Local anesthesia as a distinct comparator versus conscious sedation and general anesthesia in endovascular stroke treatment: a systematic review and meta-analysis. J Neurointerv Surg. 2022;14(3):221–6.
doi: 10.1136/neurintsurg-2021-017360
pubmed: 33758063
Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M, STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg. 2014;12(12):1500–24.
doi: 10.1016/j.ijsu.2014.07.014
pubmed: 25046751
Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, Larrue V, Bluhmki E, Davis S, Donnan G, Schneider D, Diez-Tejedor E, Trouillas P. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet. 1998;352(9136):1245–51.
doi: 10.1016/S0140-6736(98)08020-9
pubmed: 9788453
Schaller-Paule MA, Foerch C, Bohmann FO, Lapa S, Misselwitz B, Kohlhase K, Rosenow F, Strzelczyk A, Willems LM. Predicting poststroke pneumonia in patients with anterior large vessel occlusion: a prospective population-based stroke registry analysis. Front Neurol. 2022;13:8450. https://doi.org/10.3389/fneur.2022.824450 .
doi: 10.3389/fneur.2022.824450
Zhou W, Zhang Y, Jiao Y, Yin W, Dong H, Xu S, Tang D, Jiang J, Shao J, Wang Z, Yu W. Dexmedetomidine maintains blood-brain barrier integrity by inhibiting Drp1-related endothelial mitochondrial dysfunction in ischemic stroke. Acta Biochim Biophys Sin (Shanghai). 2021;53(9):1177–88.
doi: 10.1093/abbs/gmab092
pubmed: 34244711
Katzan IL, Cebul RD, Husak SH, Dawson NV, Baker DW. The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology. 2003;60(4):620–5.
doi: 10.1212/01.WNL.0000046586.38284.60
pubmed: 12601102
van de Graaf RA, Samuels N, Chalos V, Lycklama A, Nijeholt GJ, van Beusekom H, Yoo AJ, van Zwam WH, Majoie CBLM, Roos YBWEM, van Doormaal PJ, Ben Hassen W, van der Lugt A, Dippel DWJ, Lingsma HF, van Es ACGM, Roozenbeek B, MR CLEAN Registry Investigators. Predictors of poor outcome despite successful endovascular treatment for ischemic stroke: results from the MR CLEAN Registry. J Neurointerv Surg. 2022;14(7):660–5.
doi: 10.1136/neurintsurg-2021-017726
pubmed: 34266905
Yuan MZ, Li F, Tian X, Wang W, Jia M, Wang XF, Liu GW. Risk factors for lung infection in stroke patients: a meta-analysis of observational studies. Expert Rev Anti Infect Ther. 2015;13(10):1289–98.
doi: 10.1586/14787210.2015.1085302
pubmed: 26359533
Souza JT, Ribeiro PW, de Paiva SAR, Tanni SE, Minicucci MF, Zornoff LAM, Polegato BF, Bazan SGZ, Modolo GP, Bazan R, Azevedo PS. Dysphagia and tube feeding after stroke are associated with poorer functional and mortality outcomes. Clin Nutr. 2020;39(9):2786–92.
doi: 10.1016/j.clnu.2019.11.042
pubmed: 31866129
Li Y, Zhang Y, Ma L, Niu X, Chang J. Risk of stroke-associated pneumonia during hospitalization: predictive ability of combined A2DS2 score and hyperglycemia. BMC Neurol. 2019;19(1):298.
doi: 10.1186/s12883-019-1497-x
pubmed: 31766993
pmcid: 6876087
Eltringham SA, Kilner K, Gee M, Sage K, Bray BD, Smith CJ, Pownall S. Factors associated with risk of stroke-associated pneumonia in patients with dysphagia: a systematic review. Dysphagia. 2020;35(5):735–44.
doi: 10.1007/s00455-019-10061-6
pubmed: 31493069
Zhang X, Yu S, Wei L, Ye R, Lin M, Li X, Li G, Cai Y, Zhao M. The A2DS2 score as a predictor of pneumonia and in-hospital death after acute ischemic stroke in Chinese populations. PLoS ONE. 2016;11(3): e0150298.
doi: 10.1371/journal.pone.0150298
pubmed: 26950337
pmcid: 4780726
Samuels N, van de Graaf RA, van den Berg CAL, Nieboer D, Eralp I, Treurniet KM, Emmer BJ, Immink RV, Majoie CBLM, van Zwam WH, Bokkers RPH, Uyttenboogaart M, van Hasselt BAAM, Mühling J, Burke JF, Roozenbeek B, van der Lugt A, Dippel DWJ, Lingsma HF, van Es ACGM, MR CLEAN Registry Investigators. Blood pressure during endovascular treatment under conscious sedation or local anesthesia. Neurology. 2021;96(2):e171–81.
pubmed: 33028664
pmcid: 7905780