The effect of anesthetic management during intra-arterial therapy for acute stroke in MR CLEAN.

Berkhemer, Olvert A; van den Berg, Lucie A; Fransen, Puck S S; Beumer, Debbie; Yoo, Albert J; Lingsma, Hester F; Schonewille, Wouter J; van den Berg, René; Wermer, Marieke J H; Boiten, Jelis; Lycklama À Nijeholt, Geert J; Nederkoorn, Paul J; Hollmann, Markus W; van Zwam, Wim H; van der Lugt, Aad; van Oostenbrugge, Robert J; Majoie, Charles B L M; Dippel, Diederik W J; Roos, Yvo B W E M and Mattle, Heinrich (2016). The effect of anesthetic management during intra-arterial therapy for acute stroke in MR CLEAN. Neurology, 87(7), pp. 656-664. Lippincott Williams & Wilkins 10.1212/WNL.0000000000002976

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BACKGROUND The aim of the current study was to assess the influence of anesthetic management on the effect of treatment in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN). METHODS MR CLEAN was a multicenter, randomized, open-label trial of intra-arterial therapy (IAT) vs no IAT. The intended anesthetic management at the start of the procedure was used for this post hoc analysis. The primary effect parameter was the adjusted common odds ratio (acOR) for a shift in direction of a better outcome on the modified Rankin Scale (mRS) at 90 days, estimated with multivariable ordinal logistic regression analysis, which included a term for general anesthesia (GA). RESULTS GA was associated with significant (p = 0.011) effect modification, resulting in estimated decrease of 51% (95% confidence interval [CI] 31%-86%) in treatment effect compared to non-GA. We found a shift in the distribution on the mRS in favor of non-GA compared to control group (acOR 2.18 [95% CI 1.49-3.20]). The shift in distribution between GA and control group was in a similar direction (acOR 1.12 [95% CI 0.71-1.78]) with loss of statistical significance. CONCLUSIONS In this post hoc analysis, we found that the type of anesthetic management influences outcome following IAT. Only treatment without general anesthesia was associated with a significant treatment benefit in MR CLEAN. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with acute ischemic stroke undergoing IAT, mRS scores at 90 days improve only in patients treated without GA.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DCR Unit Sahli Building > Forschungsgruppe Neurologie
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Mattle, Heinrich

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0028-3878

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Stefanie Hetzenecker

Date Deposited:

29 Mar 2017 09:34

Last Modified:

29 Mar 2017 09:34

Publisher DOI:

10.1212/WNL.0000000000002976

PubMed ID:

27421546

BORIS DOI:

10.7892/boris.93263

URI:

https://boris.unibe.ch/id/eprint/93263

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