scholarly journals Association of local anesthesia versus conscious sedation with functional outcome of acute ischemic stroke patients undergoing embolectomy

2020 ◽  
Vol 26 (4) ◽  
pp. 396-404
Author(s):  
Joseph T Marion ◽  
Seyed Mohammad Seyedsaadat ◽  
Jeffery J Pasternak ◽  
Alejandro A Rabinstein ◽  
David F Kallmes ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
General Anesthesia ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Scale Score ◽  
Local Anesthesia ◽  
Conscious Sedation ◽  
Modified Rankin Scale ◽  
Hemodynamic Parameters ◽  
Stroke Patients

Purpose Compare functional outcomes of acute ischemic stroke patients undergoing embolectomy with either local anesthesia or conscious sedation. Secondarily, identify differences in hemodynamic parameters and complication rates between groups. Materials and methods Single institution, retrospective review of all acute ischemic stroke patients undergoing embolectomy between January 2014 and July 2018 ( n = 185). Patients receiving general anesthesia ( n = 27) were excluded. One-hundred and eleven of 158 (70.3%) composed the local anesthesia group, and 47 (29.7%) composed the conscious sedation group. Median age was 71 years (interquartile range 59–79). Seventy-eight (49.4%) were male. The median National Institute of Health stroke scale score was 17.5 (interquartile range 11–21). Hemodynamic, medication, complication, and functional outcome data were collected from the anesthesia protocol and medical records. Good functional outcome was defined as a three-month modified Rankin Scale < 2. A multivariate analysis was performed to estimate the association of anesthesia type on three-month modified Rankin Scale score. Results Three-month modified Rankin Scale score <2 was similar between groups ( p = 0.5). Patients receiving conscious sedation were on average younger than patients receiving local anesthesia ( p = 0.01). Conscious sedation patients were more likely to receive intravenous thrombolytic prior to embolectomy ( p = 0.025). The complication rate and hemodynamic parameters were similar between groups. Conclusion Functional outcome of acute ischemic stroke patients undergoing embolectomy appears to be similar for patients receiving local anesthesia and conscious sedation. This similarity may be beneficial to a future study comparing general anesthesia to local anesthesia and conscious sedation. The use of local anesthesia or conscious sedation does not significantly impact hemodynamic status.

Abstract 268: Is There a Weekend Effect on Telestroke Code Time Metrics?

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Ganesh Asaithambi ◽  
Amy L Castle ◽  
Emily H Marino ◽  
Bridget M Ho ◽  
Sandra K Hanson
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Mortality Rates ◽  
Weekend Effect ◽  
Favorable Outcome ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Code Process

Background: It has been suggested that there is a “weekend effect” resulting in higher mortality rates for stroke patients admitted on weekends. We examine this phenomenon for acute ischemic stroke (AIS) patients presenting to telestroke (TS) sites to determine its effect on stroke code process times and outcomes. Methods: From October 2015-June 2017, we reviewed consecutive AIS patients receiving IV alteplase within our TS network who then were transferred to our CSC. We compared patients presenting to TS sites on weekdays (Monday 0700 to Friday 1859) to patients presenting on weekends (Friday 1900 to Monday 0659). We analyzed door to code activation, code activation to TS evaluation, door to imaging, and door to needle times. Rates of favorable outcome (modified Rankin Scale score ≤2) and death at 90 days were compared. Results: We identified 89 (54 weekday, 35 weekend) patients (mean age 71.8±13.3 years, 47.2% women) during the study period. Median door to code activation (15 [5, 27] vs 8 [1, 17] mins, p=0.01) and door to needle (61 [49, 73] vs 47 [35, 59] mins, p=0.003) times were significantly longer for patients presenting on weekends compared to weekdays. There were no significant differences in median door to imaging (weekend 17 [7, 30] vs weekday 11 [6, 21], p=0.1) and code activation to TS evaluation (weekend 7 [6, 10] vs weekday 5 [4, 9], p=0.14) times. The rates of favorable outcome (weekend 50% vs weekday 66.7%, p=0.18) and death (weekend 8.3% vs weekday 4.8%, p=0.56) at 90 days were not significantly different. Conclusion: While there were no significant differences in outcomes, the “weekend effect” results in slower door to code activation and door to needle times. Efforts to improve methods in increasing efficiency of care on weekends should be considered.

scholarly journals Conscious sedation or local anesthesia during endovascular treatment for acute ischemic stroke

Neurology ◽  
2018 ◽  
Vol 91 (1) ◽  
pp. e19-e25 ◽  
Author(s):  
Rob A. van de Graaf ◽  
Noor Samuels ◽  
Maxim J.H.L. Mulder ◽  
Ismail Eralp ◽  
Adriaan C.G.M. van Es ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Local Anesthesia ◽  
Primary Outcome ◽  
Conscious Sedation ◽  
Medical Center ◽  
Complication Rates ◽  
Poor Functional Outcome

ObjectiveTo investigate the effect of conscious sedation (CS) on functional outcome and complication rates after intra-arterial treatment (IAT) for acute ischemic stroke (AIS) compared to the use of local anesthesia (LA) at the puncture site only.MethodsPatients undergoing IAT for AIS with CS or LA in the Erasmus University Medical Center from March 2014 to June 2016 were included for analysis. The primary outcome was the score on the ordinal modified Rankin Scale (mRS). We compared CS to LA by ordinal logistic regression with covariate adjustment using propensity scoring.ResultsIn 146 AIS patients treated with IAT, use of CS was associated with a shift towards worse mRS scores (odds ratio [OR] 0.4 [95% confidence interval (CI) 0.2–0.7]) compared to LA. Mortality after 90 days was higher in the CS group compared to the LA group (OR 2.3 [95% CI 1.0–5.2]). No differences between groups were noted with regard to procedure duration (8 minutes, β = 6.3 [95% CI −7.4 to 20.0]) or occurrence of procedure-related complications (OR 1.3 [95% CI 0.6–2.7]).ConclusionCS was associated with poor functional outcome and increased mortality rates compared to LA. Furthermore, CS did not reduce duration of intervention or interventional complications. CS during IAT for AIS is of no benefit if LA is considered safe.Classification of evidenceThis study provides Class II evidence, because of nonrandom allocation, that for patients with AIS undergoing IAT, LA rather than CS improves functional outcome.

Middle Cerebral Artery M2 Thrombectomy in the STRATIS Registry

Stroke ◽  
2021 ◽  
Author(s):  
Mouhammad A. Jumaa ◽  
Alicia C. Castonguay ◽  
Hisham Salahuddin ◽  
Ashutosh P. Jadhav ◽  
Kaustubh Limaye ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Scale Score ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Good Functional Outcome ◽  
First Choice

Background and Purpose: The safety and benefit of mechanical thrombectomy in the treatment of acute ischemic stroke patients with M2 segment middle cerebral artery occlusions remain uncertain. Here, we compare clinical and angiographic outcomes in M2 versus M1 occlusions in the STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) Registry. Methods: The STRATIS Registry was a prospective, multicenter, nonrandomized, observational study of acute ischemic stroke large vessel occlusion patients treated with the Solitaire stent-retriever as the first-choice therapy within 8 hours from symptoms onset. Primary outcome was defined as functional disability at 3 months measured by dichotomized modified Rankin Scale. Secondary outcomes included reperfusion rates and rates of symptomatic intracranial hemorrhage. Results: A total of 984 patients were included, of which 538 (54.7%) had M1 and 170 (17.3%) had M2 occlusions. Baseline demographics were well balanced within the groups, with the exception of mean baseline National Institutes of Health Stroke Scale score which was significantly higher in the M1 population (17.3±5.5 versus 15.7±5.0, P ≤0.001). No difference was seen in mean puncture to revascularization times between the cohorts (46.0±27.8 versus 45.1±29.5 minutes, P =0.75). Rates of successful reperfusion (modified Thrombolysis in Cerebral Infarction≥2b) were similar between the groups (91% versus 95%, P =0.09). M2 patients had significantly increased rates of symptomatic ICH at 24 hours (4% versus 1%, P =0.01). Rates of good functional outcome (modified Rankin Scale score of 0–2; 58% versus 59%, P =0.83) and mortality (15% versus 14%, P =0.75) were similar between the 2 groups. There was no difference in the association of outcome and onset to groin puncture or onset to successful reperfusion in M1 and M2 occlusions. Conclusions: In the STRATIS Registry, M2 occlusions achieved similar rates of successful reperfusion, good functional outcome, and mortality, although increased rates of symptomatic ICH were demonstrated when compared with M1 occlusions. The time dependence of benefit was also similar between the 2 groups. Further studies are needed to understand the benefit of mechanical thrombectomy for M2 occlusions. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02239640.

scholarly journals National Institutes of Health Stroke Scale Zero Strokes

Stroke ◽  
2018 ◽  
Vol 49 (12) ◽  
pp. 3057-3059
Author(s):  
Elissavet Eskioglou ◽  
Mitra Huchmandzadeh Millotte ◽  
Michael Amiguet ◽  
Patrik Michel
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Significant Proportion ◽  
National Institutes Of Health ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Recurrence Rates ◽  
Long Term Outcome

Background and Purpose— We aimed to characterize acute ischemic stroke patients who have an immeasurable deficit on the admission National Institutes of Health Stroke Scale (NIHSS), and to evaluate their long-term outcome. Methods— We retrospectively compared all acute ischemic stroke patients with an admission NIHSS of 0 in the Acute Stroke Registry and Analysis of Lausanne from 2003 to 2013 with all other acute ischemic stroke patients. We compared demographics, clinical, radiological, and laboratory findings. Outcome was considered favorable at 3 months if the modified Rankin Scale score corrected for prestroke disability was ≤1. Stroke recurrences >12 months were also assessed. Results— Comparing 108 NIHSS zero (NIHSS=0) patients with the 2889 other strokes by multivariate analysis, NIHSS=0 had lower prestroke disability, longer onset-to-hospital delays and more lacunar and infratentorial strokes. NIHSS=0 patients were less likely to have early ischemic changes on acute computed tomography, had less arterial pathology and lower creatinine levels. They were more likely to have favorable modified Rankin Scale score after correction for prestroke modified Rankin Scale score (zero versus others: 83.2% versus 44.6%) and less likely to die (3.9% versus 13.3%) at 12 months. Stroke and transient ischemic attack recurrence rates were similar (11% versus 11.4%), however. Conclusions— Patients with NIHSS=0 strokes are characterized by lacunar and infrantentorial strokes, normal acute computed tomography, and less arterial pathology. However, a significant proportion face recurrent ischemic events and persistent handicap at 12 months. Therefore, NIHSS=0 stroke patients require aggressive secondary prevention and adequate follow-up.

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

Neurology ◽  
2019 ◽  
Vol 94 (1) ◽  
pp. e97-e106 ◽  
Author(s):  
Robert-Jan B. Goldhoorn ◽  
Marie Louise E. Bernsen ◽  
Jeannette Hofmeijer ◽  
Jasper M. Martens ◽  
Hester F. Lingsma ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Scale Score ◽  
Anesthetic Management ◽  
Anesthetic Technique ◽  
Modified Rankin Scale ◽  
Class Iii ◽  
Mr Clean

ObjectiveTo 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.MethodsData 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.ResultsA 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 cORadj 0.75; 95% confidence interval [CI] 0.58–0.97; CS cORadj 0.45; 95% CI 0.33–0.62). CS was associated with worse functional outcome than GA (cORadj 0.60; 95% CI 0.42–0.87).ConclusionsLA 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.Classification of evidenceThis study provides Class III evidence that for patients with acute ischemic stroke undergoing EVT, LA improves functional outcome compared to GA or CS.

scholarly journals Clinical Course of Acute Ischemic Stroke Due to Medium Vessel Occlusion With and Without Intravenous Alteplase Treatment

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3232-3240 ◽  
Author(s):  
Johanna M. Ospel ◽  
Bijoy K. Menon ◽  
Andrew M. Demchuk ◽  
Mohammed A. Almekhlafi ◽  
Nima Kashani ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Scale Score ◽  
Odds Ratio ◽  
Clinical Course ◽  
Functional Independence ◽  
Modified Rankin Scale ◽  
Excellent Functional Outcome ◽  
Intravenous Alteplase

Background and Purpose: Available data on the clinical course of patients with acute ischemic stroke due to medium vessel occlusion (MeVO) are mostly limited to those with M2 segment occlusions. Outcomes are generally better compared with more proximal occlusions, but many patients will still suffer from severe morbidity. We aimed to determine the clinical course of acute ischemic stroke due to MeVO with and without intravenous alteplase treatment. Methods: Patients with MeVO (M2/M3/A2/A3/P2/P3 occlusion) from the INTERRSeCT (The Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography) and PRoveIT (Precise and Rapid Assessment of Collaterals Using Multi-Phase CTA in the Triage of Patients With Acute Ischemic Stroke for IA Therapy) studies were included. Baseline characteristics and clinical outcomes were summarized using descriptive statistics. The primary outcome was a modified Rankin Scale score of 0 to 1 at 90 days, describing excellent functional outcome. Secondary outcomes were the common odds ratio for a 1-point shift across the modified Rankin Scale and functional independence, defined as modified Rankin Scale score of 0 to 2. We compared outcomes between patients with versus without intravenous alteplase treatment and between patients who did and did not show recanalization on follow-up computed tomography angiography. Logistic regression was used to provide adjusted effect-size estimates. Results: Among 258 patients with MeVO, the median baseline National Institutes of Health Stroke Scale score was 7 (interquartile range: 5–12). A total of 72.1% (186/258) patients were treated with intravenous alteplase and in 41.8% (84/201), recanalization of the occlusion (revised arterial occlusive lesion score 2b/3) was seen on follow-up computed tomography angiography. Excellent functional outcome was achieved by 50.0% (129/258), and 67.4% (174/258) patients gained functional independence, while 8.9% (23/258) patients died within 90 days. Recanalization was observed in 21.4% (9/42) patients who were not treated with alteplase and 47.2% (75/159) patients treated with alteplase ( P =0.003). Early recanalization (adjusted odds ratio, 2.29 [95% CI, 1.23–4.28]) was significantly associated with excellent functional outcome, while intravenous alteplase was not (adjusted odds ratio, 1.70 [95% CI, 0.88–3.25]). Conclusions: One of every 2 patients with MeVO did not achieve excellent clinical outcome at 90 days with best medical management. Early recanalization was strongly associated with excellent outcome but occurred in <50% of patients despite intravenous alteplase treatment.

Sign in / Sign up

Export Citation Format

Share Document