General anesthesia or conscious sedation for endovascular therapy of basilar artery occlusions: ETIS registry results

Skutecki, J.; Audibert, G.; Finitsis, Stephanos; Consoli, Arturo; Lapergue, Bertrand; Blanc, Raphaël; Bourcier, Romain; Sibon, Igor; Eugène, François; Vannier, Stéphane; Dargazanli, Cyril; Arquizan, Caroline; Anxionnat, René; Richard, Sébastien; Fahed, Robert; Marnat, Gaultier; Gory, Benjamin

doi:10.1016/j.neurol.2022.03.020

Cited by 6 publications

(7 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These studies and the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) meta-analysis showed better functional outcomes in patients receiving non-GA. 3,5,[32][33][34][35] However, the randomized controlled trials have shown comparable or even worse outcomes in patients receiving non-GA. 11,13 In addition, a few observational studies investigated whether different anesthesia modality affects outcomes in patients with BAO. Similar to the studies of large vessel occlusion in the anterior circulation, these studies also suggested comparable or better functional outcomes in patients receiving non-GA. [15][16][17]19 In this study, non-GA patients had a comparable 90-day mRS to those who received GA. In addition, the null association between anesthetic management and clinical outcomes from patients who received EVT in the ATTENTION RCT trial served as adjunctive support for our findings.…”

Section: Discussionmentioning

confidence: 73%

“…[11][12][13][14] Several observational studies have investigated the effect of anesthetic management in BAO patients, whereby the clinical and safety outcomes under CS/LA appeared similar or better than GA for stroke due to acute BAO. [15][16][17][18][19][20][21][22] A small exploratory randomized controlled trial including 43 acute posterior circulation stroke patients in the GA group and 44 in the CS group suggested that the occurrence of functional independence at 90 days was not associated with the assignment of anesthetic modality (GA 48.8% vs. CS 54.5%; risk ratio, 0.89; 95% confidence interval [CI], 0.58-1.38). 23 In this subanalysis of the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) registry, we aimed to investigate the effects of anesthetic strategies on the clinical and safety outcomes in patients with BAO who underwent EVT.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Anesthetic Management and Outcomes of Endovascular Treatment of Basilar Artery Occlusion: Results From the ATTENTION Registry

Tao,

Yuan,

et al. 2023

J Stroke

View full text Add to dashboard Cite

Background and Purpose To examine the clinical and safety outcomes after endovascular treatment (EVT) for acute basilar artery occlusion (BAO) with different anesthetic modalities.Methods This was a retrospective analysis using data from the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) registry. Patients were divided into two groups defined by anesthetic modality performed during EVT: general anesthesia (GA) or non-general anesthesia (non-GA). The association between anesthetic management and clinical outcomes was evaluated in a propensity score matched (PSM) cohort and an inverse probability of treatment weighting (IPTW) cohort to adjust for imbalances between the two groups.Results Our analytic sample included 1,672 patients from 48 centers. The anesthetic modality was GA in 769 (46.0%) and non-GA in 903 (54.0%) patients. In our primary analysis with the PSM-based cohort, non-GA was comparable to GA concerning the primary outcome (adjusted common odds ratio [acOR], 1.01; 95% confidence interval [CI], 0.82 to 1.25; <i>P</i>=0.91). Mortality at 90 days was 38.4% in the GA group and 35.8% in the non-GA group (adjusted risk ratio, 0.95; 95% CI, 0.83 to 1.08; <i>P</i>=0.44). In our secondary analysis with the IPTW-based cohort, the anesthetic modality was significantly associated with the distribution of modified Rankin Scale at 90 days (acOR: 1.45 [95% CI: 1.20 to 1.75]).Conclusion In this nationally-representative observational study, acute ischemic stroke patients due to BAO undergoing EVT without GA had similar clinical and safety outcomes compared with patients treated with GA. These findings provide the basis for large-scale randomized controlled trials to test whether anesthetic management provides meaningful clinical effects for patients undergoing EVT.

show abstract

Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Anesthetic Management and Outcomes of Endovascular Treatment of Basilar Artery Occlusion: Results From the ATTENTION Registry

Tao,

Yuan,

et al. 2023

J Stroke

View full text Add to dashboard Cite

show abstract

“…Regarding the adjusted effect size for the risk of 30-day mortality, 8 articles reported adjusted effect sizes, with four articles [ 26 , 49 , 60 , 70 ] presenting OR values and four articles [ 7 , 30 , 50 , 51 ] presenting HR. The pooled analysis of the OR values indicated a significant difference between the sedation and GA groups (RR = 0.64, 95% CI: 0.56 to 0.74, p < 0.001), involving a total of 28,787 patients, with non-significant heterogeneity (I 2 = 0%, p = 0.69) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Four articles [ 56 , 60 , 65 , 70 ] reported the adjusted effect size regarding the relationship between sedation/GA and 90-day mortality, all of which provided OR values. In contrast to the pooled results of deaths, the pooled analysis of the effect values showed no significant difference between the two groups (RR = 0.68, 95% CI: 0.41 to 1.16, p = 0.16), involving a total of 18,061 patients, with non-significant heterogeneity (I 2 = 0%, p = 0.79).…”

Section: Resultsmentioning

confidence: 99%

Sedation versus general anesthesia on all-cause mortality in patients undergoing percutaneous procedures: a systematic review and meta-analysis

Su,

Zhao,

Zhang

et al. 2024

BMC Anesthesiol

View full text Add to dashboard Cite

Background The comparison between sedation and general anesthesia (GA) in terms of all-cause mortality remains a subject of ongoing debate. The primary objective of our study was to investigate the impact of GA and sedation on all-cause mortality in order to provide clarity on this controversial topic. Methods A systematic review and meta-analysis were conducted, incorporating cohort studies and RCTs about postoperative all-cause mortality. Comprehensive searches were performed in the PubMed, EMBASE, and Cochrane Library databases, with the search period extending until February 28, 2023. Two independent reviewers extracted the relevant information, including the number of deaths, survivals, and risk effect values at various time points following surgery, and these data were subsequently pooled and analyzed using a random effects model. Results A total of 58 studies were included in the analysis, with a majority focusing on endovascular surgery. The findings of our analysis indicated that, overall, and in most subgroup analyses, sedation exhibited superiority over GA in terms of in-hospital and 30-day mortality. However, no significant difference was observed in subgroup analyses specific to cerebrovascular surgery. About 90-day mortality, the majority of studies centered around cerebrovascular surgery. Although the overall pooled results showed a difference between sedation and GA, no distinction was observed between the pooled ORs and the subgroup analyses based on RCTs and matched cohort studies. For one-year all-cause mortality, all included studies focused on cardiac and macrovascular surgery. No difference was found between the HRs and the results derived from RCTs and matched cohort studies. Conclusions The results suggested a potential superiority of sedation over GA, particularly in the context of cardiac and macrovascular surgery, mitigating the risk of in-hospital and 30-day death. However, for the longer postoperative periods, this difference remains uncertain. Trial registration PROSPERO CRD42023399151; registered 24 February 2023.

show abstract

“…既往研究认为，影响急性基底动脉闭塞患者神经功能结局的因素有年龄、糖尿病、高血压、基线NIHSS评分、后循环Alberta卒中项目早期评分、后循环侧支循环评分、起病到穿刺时间、穿刺到再灌注时间、症状性出血转化等［ 9 ］。此外，病因分型［ 10 - 11 ］、麻醉方式［ 12 - 13 ］、手术方式［ 14 - 15 ］等对急性基底动脉闭塞患者神经功能结局的影响目前尚存在争议。本研究基于一多中心数据库的大样本，探究急性基底动脉闭塞患者血管内治疗后发生无效再通的影响因素，以期为临床诊疗提供指导。…”

unclassified

Influencing factors of futile recanalization after endovascular intervention in patients with acute basilar artery occlusion

YAN,

ZHANG,

ZHONG

et al. 2024

J Zhejiang Univ (Med Sci)

View full text Add to dashboard Cite

目的探索急性基底动脉闭塞患者接受血管内治疗后发生无效再通的影响因素。方法对2017年1月至2022年11月影像学证实为急性基底动脉闭塞并在发病24 h内行血管内治疗的急性缺血性脑卒中患者的临床资料（来源于CASE-Ⅱ研究，NCT04487340）进行回顾性分析。以血管内治疗后改良脑梗死溶栓（mTICI）分级为2b级或3级，但3个月改良Rankin量表评分超过2分为无效再通，采用二元logistic回归模型分析发生无效再通的影响因素。结果共纳入患者471例，平均年龄为68（57，74）岁，男性占比为68.9%，其中298（63.27%）例发生了无效再通。多因素分析显示，急性基底动脉闭塞血管内治疗无效再通的保护性因素包括合并心房颤动（ OR =0.456，95% CI ：0.282~0.737， P <0.01）、桥接静脉溶栓（ OR =0.640，95% CI ：0.416~0.985， P <0.05）、mTICI分级3级（ OR =0.554，95% CI ：0.334~0.918， P <0.05）、动脉闭塞性病变分级3级（ OR =0.521，95% CI ：0.326~0.834， P <0.01）、术后早期他汀类药物治疗（ OR =0.509，95% CI ：0.273~0.948， P <0.05）；而危险性因素包括基线美国国立卫生院卒中量表评分高（ OR =1.068，95% CI ：1.049~1.087， P <0.01）、合并高血压病（ OR =1.571，95% CI ：1.017~2.427， P <0.05）、取栓次数多（ OR =1.237，95% CI ：1.029~1.488， P <0.05）、术后24 h发生出血转化（ OR =8.497，95% CI ：2.879~25.076， P <0.01）。此外，心源性栓塞（ OR =0.321，95% CI ：0.193~0.534， P <0.01）和其他类型ORG 10172急性脑卒中治疗分类试验（TOAST）分型（ OR =0.499，95% CI ：0.260~0.961， P <0.05）与发生更低比例的无效再通相关。结论急性基底动脉闭塞患者接受血管内治疗后发生无效再通比例高，血管内治疗前桥接静脉溶栓和术后早期应用他汀类药可能可以降低无效再通的发生率。

show abstract

General anesthesia or conscious sedation for endovascular therapy of basilar artery occlusions: ETIS registry results

Cited by 6 publications

References 26 publications

Anesthetic Management and Outcomes of Endovascular Treatment of Basilar Artery Occlusion: Results From the ATTENTION Registry

Anesthetic Management and Outcomes of Endovascular Treatment of Basilar Artery Occlusion: Results From the ATTENTION Registry

Sedation versus general anesthesia on all-cause mortality in patients undergoing percutaneous procedures: a systematic review and meta-analysis

Influencing factors of futile recanalization after endovascular intervention in patients with acute basilar artery occlusion

Contact Info

Product

Resources

About