Circulatory and Respiratory Parameters during Acute Endovascular Stroke Therapy in Conscious Sedation or General Anesthesia

Mundiyanapurath, Sibu; Schönenberger, Silvia; Rosales, Maritoni L.; Romeiro, Ana M. Carrilho; Möhlenbruch, Markus; Bendszus, Martin; Hacke, Werner; Bösel, Julian

doi:10.1016/j.jstrokecerebrovasdis.2015.01.025

Cited by 29 publications

(20 citation statements)

References 34 publications

(34 reference statements)

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“…Recently, a systematic review on this subject found an association between BP drops during MT and functional outcome 15. Interestingly, this association was no longer present in four studies, three of them being undertaken with strict BP targets during MT,26–28 two of them being post-hoc analysis27 28 of a quality randomized controlled trial evaluating GA versus CS during MT 7 8. In addition to acknowledging these previous results, our study seems to further support the notion that hypotension during MT is linearly associated with worse prognosis in both sedation modalities.…”

Section: Discussionsupporting

confidence: 73%

“…The linear associations between functional outcome and hypotension duration were determined for any BP drops during MT from the baseline BP measured in the interventional suit. As stated previously, a number of retrospective studies have already suggested a deleterious impact of hypotension during MT 15 16 26–30. However, these studies have limitations such as low recanalization rates with the use of first generation stent retriever16 that are no longer relevant to everyday practice, and also do not entirely provide an understanding of the specific pathophysiological mechanisms regarding the deleterious effects of hypotension.…”

Section: Discussionmentioning

confidence: 99%

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A 10% blood pressure drop from baseline during mechanical thrombectomy for stroke is strongly associated with worse neurological outcomes

Valent

Sajadhoussen

Maïer

et al. 2019

J NeuroIntervent Surg

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BackgroundMechanical thrombectomy (MT) for acute ischemic stroke can be performed under local anesthesia, with or without conscious sedation (CS), or under general anesthesia (GA). The hemodynamic consequence of anesthetic drugs may explain why GA may be associated with worse outcomes. We evaluated the association between hypotension duration during MT and the 90 day functional outcome under both anesthetic regimens.MethodsPatients were included in this retrospective study if they had an ischemic stroke treated by MT under GA or CS. The main exposure variable was the time below 90% of the reference value of arterial pressure measured before MT. The primary outcome was poor functional outcome defined as a 90 day modified Rankin Score ≥3.Results371 patients were included in the study. GA was performed in 42%. A linear association between the duration of arterial hypotension and outcome was observed. The odds ratio for poor functional outcome of 10 min under 90% of the baseline mean arterial pressure was 1.13 (95% CI 1.06 to 1.21) without adjustment and 1.11 (95% CI 1.02 to 1.21) after adjustment for confounding factors. The functional outcome was poorer for patients treated under GA compared with CS, but the association with the depth of hypotension remained similar under both conditions.ConclusionIn this study, we observed a linear association between the duration of hypotension during MT and the functional outcome at 90 days. An aggressive and personalized strategy for the treatment of hypotension should be considered. Further trials should be conducted to address this question.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

A 10% blood pressure drop from baseline during mechanical thrombectomy for stroke is strongly associated with worse neurological outcomes

Valent

Sajadhoussen

Maïer

et al. 2019

J NeuroIntervent Surg

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“…Finally, 16 articles were included in the meta-analysis. [2][3][4][5][17][18][19][20][21][22][23][24][25][26][27][28] Detailed information on the baseline characteristics are described in Table 1. The mean age for each study ranged between 60.4 and 78.3 years.…”

Section: Literature Searchmentioning

confidence: 99%

Influence of Anesthesia Type on Outcomes after Endovascular Treatment in Acute Ischemic Stroke: Meta-Analysis

Kim

Kim²,

Jeon

2019

Neurointervention

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To assess clinical and angiographic outcomes after endovascular treatment (EVT) in ischemic stroke patients according to anesthesia types (general anesthesia vs. conscious sedation). Materials and Methods: A systematic literature review through an online data base between January 1990 and September 2017 was performed. A fixed effect model was used in cases of <50% heterogeneity. The primary outcomes were good clinical outcome at the 3-month follow-up and successful recanalization. A meta-regression analysis was done to estimate primary outcomes of log odds ratio (OR) on onset-to-puncture time (OTP) differences. Publication bias was determined using Begg's funnel plot and additional the Trim and Fill method. Results: Sixteen articles including 2,662 patients (general anesthesia, n=1,275; conscious sedation, n=1,387) were included. General anesthesia significantly decreased good outcomes than conscious sedation (OR, 0.564; 95% confidence interval [CI], 0.354-0.899). However, outcomes did not differ significantly in randomized controlled trials (RCTs; OR, 1.101; 95% CI, 0.395-3.071). Anesthesia type was not associated with successful recanalization (OR, 0.985; 95% CI, 0.787-1.233). General anesthesia increased the risk of mortality (OR, 1.532; 95% CI, 1. 187-1.976) and pneumonia (OR, 1.613; 95% CI, 1.172-2.221), but not symptomatic intracranial hemorrhage (OR, 1.125; 95% CI, 0.767-1.652). The meta-regression analysis showed no linear relationship between OTP differences and log OR of good outcome (coefficient, 0.0004; P=0.95) or successful recanalization (coefficient, 0.0005; P=0.94), respectively. Conclusion: General anesthesia seemed to be associated with adverse clinical outcome after EVT. However, its efficacy was not demonstrated in RCTs. Successful recanalization did not differ according to anesthesia type. Studies using individual patient data based on further RCTs are necessary to elucidate anesthesia effect on procedural and clinical outcomes.

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“…However, the vast majority of the patients in AnStroke and SIESTA were younger. There can be greater blood pressure decreases in patients under general anesthesia ( 35 ), which can be detrimental to collateral flow. Patient cooperation, if the patient is being treated with sedation or local anesthesia, may also be an issue, especially if the patients have some level of preexisting cognitive dysfunction.…”

Section: Starting the Procedure: Anesthesia And Patient Cooperationmentioning

confidence: 99%

Endovascular Treatment of Anterior Circulation Large Vessel Occlusion in the Elderly

Jayaraman

McTaggart

2018

Front. Neurol.

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Endovascular treatment of anterior circulation large vessel occlusion in the elderly population presents special challenges and opportunities. In this review, we discuss the published literature regarding thrombectomy in elderly patients and also discuss specific issues related to treatment in this patient population. In summary, while the overall outcomes following thrombectomy in elderly patients are worse than following thrombectomy in younger patients, there appears to be a similar benefit as in young patients. While there are challenges with successfully delivering thrombectomy in older patients, age alone should not be an independent exclusion from thrombectomy.

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Circulatory and Respiratory Parameters during Acute Endovascular Stroke Therapy in Conscious Sedation or General Anesthesia

Cited by 29 publications

References 34 publications

A 10% blood pressure drop from baseline during mechanical thrombectomy for stroke is strongly associated with worse neurological outcomes

A 10% blood pressure drop from baseline during mechanical thrombectomy for stroke is strongly associated with worse neurological outcomes

Influence of Anesthesia Type on Outcomes after Endovascular Treatment in Acute Ischemic Stroke: Meta-Analysis

Endovascular Treatment of Anterior Circulation Large Vessel Occlusion in the Elderly

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