Endovascular treatment of acute ischaemic stroke under conscious sedation: Predictors of poor outcomes

Athiraman, Umeshkumar; Abdallah, Arbi Ben; Kansagra, Akash P.; Tempelhoff, René

doi:10.4103/ija.ija_487_18

Cited by 4 publications

(1 citation statement)

References 30 publications

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“…The lack of association between PA and disability rate may be due to the NIHSS score and stroke etiology in the present study. Because most strokes were attributed to cardioembolism in the PA group, these patients have a higher baseline NIHSS score, which means that the long-term poor prognosis rate of these patients will increase [24,25]. Likewise, Krieger et al [26] and Couture et al [27] found that PA in AIS patients treated with EVT signi cantly increases the risk of poor functional outcome at 90 days.…”

Section: Discussionmentioning

confidence: 99%

Prior antiplatelet is associated with better outcome for acute ischemic stroke patients treated with endovascular treatment: a prospective cohort study in China

Tan,

He,

Mao

et al. 2024

Preprint

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Background: There has been limited evidence and inconsistent results on the safety and effectiveness of prior antiplatelet (PA) use for acute ischemic stroke (AIS) patients treated with endovascular treatment (EVT). Methods: We prospectively enrolled consecutive patients from two comprehensive stroke centers in China from June 2015 to June 2019. The efficacy outcomes were vascular recanalization rate, early neurological function improvement (24-hour NIHSS decreased ≥4), poor prognosis at 90 days (mRS 3-6), and death at 90 days. The safety outcomes were intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH). Univariate and multivariate logistic regression was performed with SPSS 22.0. Results: A total of 298 AIS patients were included. Of them, 54 (18.1%) patients were taking antiplatelet agents before stroke. PA (OR=0.40, 95% CI 0.16-0.98, p=0.046) significantly reduced the three-month death, and this difference persisted after adjusting for clinical confounders (adjusted OR =0.29, 95% CI 0.10-0.83, p=0.021). PA (adjusted OR=0.52, 95% CI 0.26-1.06, p=0.075) was not significantly associated with three-month death or disability. There were no significant differences in successful recanalization, early neurological improvement, ICH and sICH between groups. Conclusions: For AIS patients with EVT, prior antiplatelet is safe and may reduce the risk of death at three months.

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Section: Discussionmentioning

confidence: 99%

Prior antiplatelet is associated with better outcome for acute ischemic stroke patients treated with endovascular treatment: a prospective cohort study in China

Tan,

He,

Mao

et al. 2024

Preprint

View full text Add to dashboard Cite

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Effect of Conscious Sedation vs. General Anesthesia on Outcomes in Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke: A Prospective Randomized Clinical Trial

Ren

Liu

et al. 2020

Front. Neurol.

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Background: Although several studies have compared conscious sedation (CS) with general anesthesia (GA) in patients undergoing mechanical thrombectomy (MT), there has been no affirmative conclusion. We conducted this trial to assess whether CS is superior to GA for patients undergoing MT for acute ischemic stroke (AIS).Methods: Acute ischemic stroke patients with anterior circulation large vascular occlusion were randomized into two groups. The primary outcome was modified Rankin scale score (0-2) at 90 days after stroke. Secondary outcomes included intraprocedural hemodynamics, time metrics, successful recanalization, neurointerventionalist satisfaction score, National Institutes of Health Stroke Scale (NIHSS) score, and Alberta Stroke Program Early CT Score (ASPECTS) at 48 h post-intervention, mortality at discharge and 3 months after stroke, and complications.Results: Compared with the CS group, heart rate was significantly lower at T1-T8 in the GA group except at T4 (P < 0.05). Mean arterial pressure (MAP) and systolic blood pressure were significantly lower in the GA group at T4-T6 and T9 (P < 0.05). Pulse oxygen saturation was significantly higher at T2-T9 in the GA group (P < 0.05). There were no significant differences in time metrics, vasoactive drug use, occurrence of >20% fall in MAP, pre-recanalization time spent with >20% fall in MAP, neurointerventionalist satisfaction, successful recanalization rate, NIHSS, and ASPECTS scores at 48 h post-intervention, and mortality rate at discharge and 3 months after stroke (P > 0.05). The cerebral infarction rate at 30 days was greater in the CS group, but not significantly (P > 0.05). There were no differences in complication rates except for pneumonia (P > 0.05). Conversion rate from CS to GA was 9.52%. Conclusion:Anesthetic management with GA or CS during MT had no differential impact on the functional outcomes and mortality at discharge or 3 months after stroke in AIS patients, but CS led to more stable hemodynamics and lower incidence of pneumonia.

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Acute cervical spinal disc prolapse masquerading as stroke, requiring emergency spinal surgery immediately following thrombolysis

Rajagopal¹,

Kumaresan²,

Peruru³

2021

Indian Journal of Anaesthesia

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Endovascular treatment of acute ischaemic stroke under conscious sedation: Predictors of poor outcomes

Cited by 4 publications

References 30 publications

Prior antiplatelet is associated with better outcome for acute ischemic stroke patients treated with endovascular treatment: a prospective cohort study in China

Prior antiplatelet is associated with better outcome for acute ischemic stroke patients treated with endovascular treatment: a prospective cohort study in China

Effect of Conscious Sedation vs. General Anesthesia on Outcomes in Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke: A Prospective Randomized Clinical Trial

Acute cervical spinal disc prolapse masquerading as stroke, requiring emergency spinal surgery immediately following thrombolysis

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