Effect of Conscious Sedation vs. General Anesthesia on Outcomes in Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke: A Prospective Randomized Clinical Trial

Background: The impact of anesthesia technique on the outcomes of mechanical thrombectomy for acute ischemic stroke remains an issue of debate, and has not been studied in clinical trials. We investigated the association of general anesthesia with outcomes in patients undergoing mechanical thrombectomy for ischemic stroke. Methods: We performed a cohort study involving patients undergoing mechanical thrombectomy for ischemic stroke from 2009-2013, who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database. An instrumental variable (hospital rate of general anesthesia) analysis was used to simulate the effects of randomization and investigate the association of anesthesia technique with case-fatality and length of stay (LOS). Results: Of the 1,308 patients undergoing mechanical thrombectomy for acute ischemic stroke, 492 (37.6%) underwent general anesthesia, and 816 (62.4%) underwent conscious sedation. Employing an instrumental variable analysis, we identified that general anesthesia was associated with a 6.4% increased case-fatality (95% CI, 1.9% to 11.0%), and 8.4 days longer LOS (95% CI, 2.9 to 14.0) in comparison to conscious sedation. This corresponded to 15 patients needing to be treated with conscious sedation to prevent one death. Our results were robust in a sensitivity analysis utilizing mixed effects regression, and propensity score adjusted regression models. Conclusions: Using a comprehensive all-payer cohort of acute ischemic stroke patients undergoing mechanical thrombectomy in New York State, we identified an association of general anesthesia with increased case fatality and LOS. These considerations should be taken into account when standardizing acute stroke care.

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Abstract No. 719 Conscious sedation versus general anesthesia on outcomes in mechanical thrombectomy for patients with acute ischemic stroke

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2019.12.778 ◽

2020 ◽

Vol 31 (3) ◽

pp. S309-S310

Author(s):

R. Le ◽

A. Hoefnagel ◽

J. Yao ◽

D. Rao

Keyword(s):

Ischemic Stroke ◽

General Anesthesia ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Conscious Sedation

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A Randomized Clinical Trial of Conscious Sedation vs General Anesthesia on Outcomes in Patients Receiving Thrombectomy for Ischemic Stroke

Neurosurgery ◽

10.1093/neuros/nyx113 ◽

2017 ◽

Vol 80 (5) ◽

pp. N27-N28

Author(s):

Robert M. Starke ◽

Eric C. Peterson ◽

Ricardo J. Komotar ◽

E. Sander Connolly

Keyword(s):

Clinical Trial ◽

Ischemic Stroke ◽

General Anesthesia ◽

Randomized Clinical Trial ◽

Conscious Sedation

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Endovascular Mechanical Thrombectomy for Acute Ischemic Stroke Under General Anesthesia Versus Conscious Sedation: A Systematic Review and Meta-Analysis

World Neurosurgery ◽

10.1016/j.wneu.2018.01.049 ◽

2018 ◽

Vol 112 ◽

pp. e355-e367 ◽

Cited By ~ 19

Author(s):

Adeel Ilyas ◽

Ching-Jen Chen ◽

Dale Ding ◽

Paul M. Foreman ◽

Thomas J. Buell ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

General Anesthesia ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Conscious Sedation ◽

Meta Analysis ◽

Endovascular Mechanical Thrombectomy

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Blood pressure behavior during mechanical thrombectomy and drugs used for conscious sedation or general anesthesia

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x-anp-2020-0243 ◽

2021 ◽

Vol 79 (8) ◽

pp. 660-665

Author(s):

Ráissa Soraya Souza de Oliveira ◽

Vinícius Boaratti Ciarlariello ◽

Hanna Nery Ferraz Martins ◽

Michelle dos Santos Lobato ◽

Renata Carolina Acri Nunes Miranda ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Hospital Admission ◽

General Anesthesia ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Conscious Sedation ◽

Tertiary Hospital ◽

Neuromuscular Blocking ◽

Significant Drop

ABSTRACT Background: The optimal blood pressure (BP) during mechanical thrombectomy for acute ischemic stroke is currently unclear. Objective: To investigate BP behavior during mechanical thrombectomy in patients with acute ischemic stroke and its relationship with drugs used for sedation or general anesthesia. Additionally, we investigated the association between BP oscillation during mechanical thrombectomy and recanalization status, and with functional outcome at discharge. Methods: Consecutive patients treated with mechanical thrombectomy for acute ischemic stroke were evaluated in a tertiary hospital from December/2009 to December/2015. Maximum, minimum, and mean systolic and diastolic BP, and mean arterial pressures were collected during the procedure. Sedative drugs were also reviewed. Results: Fifty-three patients with a mean age of 71.9 years (60.4% men) were treated with mechanical thrombectomy. The mean reduction in systolic BP and mean arterial pressure from hospital admission to mechanical thrombectomy were respectively 42 and 36 mmHg. During the procedure, oscillations were 50.4 mmHg for systolic, and 33.2 mmHg for diastolic BP. Patients treated with neuromuscular blocking drugs had more oscillation in systolic BP from hospital admission to procedure (51.1 versus 26.2 mmHg, P=0.06). The use of cisatracurium (43.9 versus 29.6 mmHg, P=0.02) and succinylcholine (44.7 versus 29.3 mmHg, P=0.01) were associated with a significant drop in BP during the procedure. Conclusions: Significant BP oscillation occurs during mechanical thrombectomy. Drugs used for conscious sedation or general anesthesia, specifically neuromuscular blocking agents, might have an influence upon BP levels.

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