Endovaskuläre Therapie des akut ischämischen Schlaganfalls unter Analgosedierung im Vergleich zur Intubationsnarkose - Durchführbarkeit, periprozedurale Sicherheit, klinisches und radiologisches Outcome

Abstract

Abstract! Purpose: Vessel recanalization is an important predictor of clinical outcome in the treatment of acute ischemic stroke. Endovascular therapies are used with increasing frequency. There is no general agreement on the policy of anesthesia during endovascular therapy, ranging from general anesthesia (GA) to local anesthesia at the puncture site with conscious sedation (CS) as needed. The aim of the study was to evaluate the safety and feasibility and radiological and clinical outcome of endovascular stroke therapy under CS. Materials and Methods: We retrospectively included all patients with acute ischemic stroke who were treated with endovascular therapy over a five-year period. Data was evaluated with respect to type of sedation, conversion from CS to GA, recanalization rate, infarct volume and peri-and postprocedural complications. Results: There was a technical failure in 7 patients. Of the remaining 124 patients (mean age 68.8 ± 14.6 years), 65 were female (52 %). The site of occlusion was located in the anterior circulation in 94 patients (76 %) and in the posterior circulation in 30 cases (24 %). 105 patients (85 %) were treated under CS and 16 cases (13 %) primarily under GA. In 3 cases (2 %) peri-procedural conversion to GA was necessary. Primary intra-arterial thrombolysis, mechanical recanalization only, and combination therapy were performed in 60 (48 %), 27 (22 %) and 37 (30 %) patients, respectively. There were no significant differences for recanalization rate and complications between GA and CS. The mean procedure time was significantly shorter in patients treated under CS (p < 0.01). Conclusion: Endovascular stroke therapy with CS is feasible, can be performed safely and is faster than with GA.Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.Einleitung

Two in One: Endovascular Treatment of Acute Tandem Occlusions in the Anterior Circulation

“…One patient had a subarachnoid haemorrhage due to intraprocedural dissection of the anterior choroid artery, which had to be occluded using N-butyl cyanoacrylate glue. In this and two other cases intracranial hypertension due to Published literature suggests that patients treated under general anaesthesia have a longer time to recanalization [25] and poorer outcome [26] as compared with patients treated under conscious sedation. In our series, eight patients (18.6 %) were treated without general anaesthesia.…”

Choice of ANaesthesia for EndoVAScular treatment of acute ischaemic stroke at posterior circulation (CANVAS II): protocol for an exploratory randomised controlled study

“…21 22 31 In contrary, GA groups could suffer from worse neurological function, lower BP, aspiration pneumonia and/or high mortality. [34][35][36][37][38][39][40][41] A recent retrospective, matched, case-control study of patients with posterior circulation AIS is the only study to explore the effect of anaesthesia management on outcome of patients with posterior AIS, however, great limitation and drawbacks in terms of study design, including selection bias and information bias impede the credibility of the results. 21 Several confounding factors contribute to inconclusive results, including specific information of peri-interventional management, such as BP, partial pressure of carbon dioxide and strict uniform anaesthesia protocol.…”

Intubation und Sedierung bei der endovaskulären Therapie des akuten Hirninfarkts

“…Deshalb ist auch in den bereits publizierten großen Schlaganfallstudien diesbezüglich kein Prozedere standardisiert, sodass die Wahl der Narkose/Sedierung zwischen den meisten publizierten Studien nicht gut vergleichbar -falls überhaupt erhoben -ist [11].…”

“…Diese Unterschiede im Behandlungsergebnis in Abhängigkeit vom prozeduralen Management waren in einer retrospektiven Arbeit sowohl für den vorderen als auch den hinteren Stromkreislauf nachweisbar [11].…”