Choice of ANesthesia for EndoVAScular Treatment of Acute Ischemic Stroke (CANVAS): Results of the CANVAS Pilot Randomized Controlled Trial

Abstract

Background: The effect of choice of anesthesia on clinical outcome for endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) remains unclear.Methods: We conducted a pilot trial of 43 patients with acute anterior circulation ischemic stroke having EVT. Patients were randomly allocated to receive general anesthesia or conscious sedation. We documented the rate of recruitment and rate of conversion from conscious sedation to general anesthesia. In addition, we recorded the change in National Institute of Health stroke scale (NIHSS) on day 7, the rate of successful reperfusion and measured neurological function by certified researchers using modified Rankin Score (mRS 0 to 2) at 90 days. Results:The recruitment rate was 31.4% and majority of patients were excluded because of delay in hospital presentation and posterior circulation stroke. The rate of conversion from conscious sedation to general anesthesia was 18.2%. This was primarily related to excessive sedation and uncontrolled movement. Change in NIHSS score, rate of successful reperfusion and functional recovery were similar between groups.Conclusions: It was feasible to randomize AIS patients receiving either general anesthesia or conscious sedation for EVT.

General anesthesia but not conscious sedation improves functional outcome in patients receiving endovascular thrombectomy for acute ischemic stroke: A meta-analysis of randomized clinical trials and trial sequence analysis

“…The risks of bias of individual studies are summarized in Figure 2 . The anesthetic conversion rate was 5–10% and ≥10% in two ( 16 , 18 ) and three ( 14 , 15 , 17 ) studies, respectively. Accordingly, the risk of these studies were considered to be uncertain or high.…”

Anesthetic considerations for endovascular treatment in stroke therapy

“…Preintubation hypotension caused by any induction agent for GA, and hypotension during EVT potentially decreases the CBF and increases the speed of core conversion of the ischemic penumbra, resulting in larger infarct volumes [37]. In different RCTs comparing GA with CS, drops in BP variables were more profound when GA was employed [28 && , 30,32,38]. Guidelines state that systolic BP drops should be avoided during EVT and systolic BP above 150 mmHg could be useful in keeping adequate collateral blood flow, but these recommendations are based on limited data [9,10].…”

“…Preintubation hypotension caused by any induction agent for GA, and hypotension during EVT potentially decreases the CBF and increases the speed of core conversion of the ischemic penumbra, resulting in larger infarct volumes [37]. In different RCTs comparing GA with CS, drops in BP variables were more profound when GA was employed [28 ▪▪ ,30,32,38].…”

Periprocedural Management During Stroke Thrombectomy

“…With 43 patients, similar reperfusion rates and outcomes were seen, with 55% reaching independence after 90 days in the GA arm and 50% in the PS arm (p = 0.26). 28 ). A standard operative procedure for patients undergoing EVT is outlined in Figure 3.…”