Impact of Anesthesia on the Outcome of Acute Ischemic Stroke after Endovascular Treatment with the Solitaire Stent Retriever.

Slezak, Agnieszka Anna; Kurmann, Rebekka; Oppliger, L; Broeg-Morvay, Anne; Gralla, Jan; Schroth, Gerhard; Mattle, Heinrich; Arnold, Marcel; Fischer, Urs; Jung, Simon; Greif, Robert; Neff, Frank; Mordasini, Pasquale; Mono, Marie-Luise (2017). Impact of Anesthesia on the Outcome of Acute Ischemic Stroke after Endovascular Treatment with the Solitaire Stent Retriever. AJNR. American journal of neuroradiology, 38(7), pp. 1362-1367. American Society of Neuroradiology 10.3174/ajnr.A5183

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BACKGROUND AND PURPOSE

General anesthesia during endovascular treatment of acute ischemic stroke may have an adverse effect on outcome compared with conscious sedation. The aim of this study was to examine the impact of the type of anesthesia on the outcome of patients with acute ischemic stroke treated with the Solitaire stent retriever, accounting for confounding factors.

MATERIALS AND METHODS

Four-hundred one patients with consecutive acute anterior circulation stroke treated with a Solitaire stent retriever were included in this prospective analysis. Outcome was assessed after 3 months by the modified Rankin Scale.

RESULTS

One-hundred thirty-five patients (31%) underwent endovascular treatment with conscious sedation, and 266 patients (69%), with general anesthesia. Patients under general anesthesia had higher NIHSS scores on admission (17 versus 13, P < .001) and more internal carotid artery occlusions (44.6% versus 14.8%, P < .001) than patients under conscious sedation. Other baseline characteristics such as time from symptom onset to the start of endovascular treatment did not differ. Favorable outcome (mRS 0-2) was more frequent with conscious sedation (47.4% versus 32%; OR, 0.773; 95% CI, 0.646-0.925; P = .002) in univariable but not multivariable logistic regression analysis (P = .629). Mortality did not differ (P = .077). Independent predictors of outcome were age (OR, 0.95; 95% CI, 0.933-0.969; P < .001), NIHSS score (OR, 0.894; 95% CI, 0.855-0.933; P < .001), time from symptom onset to the start of endovascular treatment (OR, 0.998; 95% CI, 0.996-0.999; P = .011), diabetes mellitus (OR, 0.544; 95% CI, 0.305-0.927; P = .04), and symptomatic intracerebral hemorrhage (OR, 0.109; 95% CI, 0.028-0.428; P = .002).

CONCLUSIONS

In this single-center study, the anesthetic management during stent retriever thrombectomy with general anesthesia or conscious sedation had no impact on the outcome of patients with large-vessel occlusion in the anterior circulation.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy 04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology 04 Faculty of Medicine > Medical Education > Institute for Medical Education > Master of Medical Education (MME) 04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
UniBE Contributor:	Slezak, Agnieszka Anna, Kurmann, Rebekka, Broeg-Morvay, Anne, Gralla, Jan, Schroth, Gerhard, Mattle, Heinrich, Arnold, Marcel, Fischer, Urs Martin, Jung, Simon, Greif, Robert, Neff, Frank, Mordasini, Pasquale Ranato, Mono, Marie-Luise
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1936-959X
Publisher:	American Society of Neuroradiology
Language:	English
Submitter:	Jeannie Wurz
Date Deposited:	07 Aug 2017 10:02
Last Modified:	02 Mar 2023 23:29
Publisher DOI:	10.3174/ajnr.A5183
PubMed ID:	28473340
URI:	https://boris.unibe.ch/id/eprint/100090