General Anesthesia may have Similar Outcomes with Conscious Sedation in Thrombectomy Patients with Acute Ischemic Stroke: A Real-World Registry in China

Abstract

Background and Purpose: Clinical trials showed that anesthesia may not influence the functional outcome in stroke patients with endovascular therapy; however, data are lacking in China. Using real-world registry data, our study aims to compare the effects of general anesthesia or conscious sedation on functional outcomes in stroke patients treated with thrombectomy in China. Methods: Consecutive patients with acute anterior circulation stroke receiving thrombectomy in 21 stroke centers between January 2014 and June 2016 were included in this study. The propensity score analysis with 1: 1 ratio was used to match the baseline variables between patients with general anesthesia and the conscious sedation. The 90-day modified Rankin Scale (mRS), symptomatic intracranial hemorrhage (sICH), and death were compared between groups. Results: Of the 698 patients undergoing endovascular treatment, 138 were treated with general anesthesia and 560 with conscious sedation. After propensity score matching, 114 general anesthesia and 114 conscious sedation patients were matched. The proportions of patients with 90-day mRS 0–2 were not significantly different between general anesthesia and conscious sedation groups (41.2% [47/114] vs. 46.5% [53/114], p = 0.470), nor were the rates of sICH (21.9% [25/114] vs. 12.3% [14/114], p = 0.072) and 90-day mortality (31.6% [36/114] vs. 21.9% [25/114], p = 0.145). Conclusion: Anesthesia patterns may have no significant impacts on clinical outcomes in patients with acute anterior circulation occlusion stroke undergoing endovascular treatment in the real-world practice in China.

Outcomes of general anesthesia versus conscious sedation for Stroke undergoing endovascular treatment: a meta-analysis

“…Of the remaining 42 records, 19 records were excluded after further screen through full-text reading (10 records did not provide outcome of interest or available data, 6 reviews, and 3 abstracts). Finally, 23 records were eligible in our meta-analysis [3–5, 14–33], including 5 randomized controlled trials (RCTs) and 18 non-RCTs.

Fig. 1Flow diagram of study identification

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General Anesthesia versus Conscious Sedation in Mechanical Thrombectomy

“…The GA-rate is considerably higher than reported in data from clinical trials or registry data with about 30% of patients receiving GA (28.0% to 37.6%). [9][10][11][12] In about 12% of patients starting MT under CS, a conversion to GA was necessary (cor- 1. Modified Rankin Scale (mRS) at 3-months follow-up for all large vessel occlusion stroke (A) and for anterior circulation stroke (B).…”

The anesthetic approach for endovascular recanalization therapy depends on the lesion site in acute ischemic stroke

“…Patient condition is an essential factor for the choice of anesthetic strategy during EVT [ 4 ]. While GA constitutes the preferred anesthetic method in stroke patients with higher disability, unstable vital parameters, hypoventilation, loss of consciousness, and excessive movements, CS is often conducted in cooperative patients and is sometimes the preferred first-line strategy to avoid a delay of EVT [ 6 – 10 , 25 , 26 ].…”

“…The anesthetic method of choice for EVT depends on patients' condition, preference of the treating physician, as well as on organizational and logistic aspects of the local hospital [2,4,5]. CS is often used as an easy first-line strategy when patients are cooperative, whereas GA is preferred in patients with excessive movements, respiratory compromise, or loss of consciousness [4,[6][7][8][9][10]. Neurologic symptoms, e.g., aphasia or compromised vigilance, are related to lesions in specific brain regions [11].…”