Format

Send to

Choose Destination
Stroke. 2015 May;46(5):1257-62. doi: 10.1161/STROKEAHA.115.008699. Epub 2015 Apr 7.

Type of anesthesia and differences in clinical outcome after intra-arterial treatment for ischemic stroke.

Author information

1
From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
2
From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands. y.b.roos@amc.uva.nl.

Abstract

BACKGROUND AND PURPOSE:

Intra-arterial treatment (IAT) in patients with acute ischemic stroke (AIS) can be performed with or without general anesthesia (GA). Previous studies suggested that IAT without the use of GA (non-GA) is associated with better clinical outcome. Nevertheless, no consensus exists about the anesthetic management during IAT of AIS patients. This study investigates the association between type of anesthesia and clinical outcome in a large cohort of patients with AIS treated with IAT.

METHODS:

All consecutive patients with AIS of the anterior circulation who received IAT between 2002 and 2013 in 16 Dutch hospitals were included in the study. Primary outcome was functional outcome on the modified Rankin Scale at discharge. Difference in primary outcome between GA and non-GA was estimated using multiple ordinal regression analysis, adjusting for age, stroke severity, occlusion of the internal carotid artery terminus, previous stroke, atrial fibrillation, and diabetes mellitus.

RESULTS:

Three hundred forty-eight patients were included in the analysis; 70 patients received GA and 278 patients did not receive GA. Non-GA was significantly associated with good clinical outcome (odds ratio 2.1, 95% confidence interval 1.02-4.31). After adjusting for prespecified prognostic factors, the point estimate remained similar; statistical significance, however, was lost (odds ratio 1.9, 95% confidence interval 0.89-4.24).

CONCLUSIONS:

Our study suggests that patients with AIS of the anterior circulation undergoing IAT without GA have a higher probability of good clinical outcome compared with patients treated with general anesthesia.

KEYWORDS:

acute stroke; anesthesia; conscious sedation; thrombectomy; thrombolytic therapy

PMID:
25851766
DOI:
10.1161/STROKEAHA.115.008699
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center