General Anesthesia Versus Conscious Sedation for Endovascular Treatment of Acute Ischemic Stroke

Hendén, Pia Löwhagen; Rentzos, Alexandros; Karlsson, Jan‐Erik; Rosengren, Lars; Leiram, Birgitta; Sundeman, Henrik; Dunker, Dennis; Schnabel, Kunigunde; Wikholm, Gunnar; Hellström, Mikael; Ricksten, Sven‐Erik

doi:10.1161/strokeaha.117.016554

Cited by 339 publications

(300 citation statements)

References 26 publications

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“…In line with the randomized controlled trial-the AnStroke trial [19], we also found that conscious sedation and general anesthesia had similar clinical and safety outcomes. Consistent with the meta-analysis including IMS III and MR CLEAN trials [23], our study also showed that conscious sedation and general anesthesia The logistic regression model used for the determination of the propensity score included the following factors: age, sex, time from onset to visit, time from onset to treatment, time from onset to revascularization, occlusion site, collateral flow, ASPECTS, baseline NIHSS and intravenous thrombolysis.…”

Section: Discussionsupporting

confidence: 86%

“…Collateral flow has been popularly known as an essential predictor of outcomes in recent years. In the AnStroke trial [19] and the present study, collateral flow was included for analysis, which consequently may attenuate the effects of anesthesia on clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…However, the results of the Sedation versus Intubation for Endovascular Stroke Treatment trial [18] and the Anesthesia During Stroke (AnStroke) trial [19] detected no significant differences on neurological functional outcomes between patients with general anesthesia and those with conscious sedation. This result was confirmed by another large prospective observational study [20].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…Í þeirri rannsókn var hins vegar enginn munur á blóðþrýstingi hjá þeim sem fengu svaefingu í stað slaevingar. 47 …”

Section: Svaefing Eða Slaeving Við Innaeðameðferðunclassified

Segabrottnám við brátt blóðþurrðarslag er mesta framför í læknisfræði í áraraðir

Sigurdsson

2018

LBL

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“…shows that our search strategy finally incorporates 13 studies (3 RCTs(Löwhagen Hendén et al, 2017;Schönenberger et al, 2016;Simonsen et al, 2018) and 10 observational studies(Abou- Chebl et al, 2010;Abou-Chebl et al, 2014;Berg et al, 2015;Bracard et al, 2016;John et al, 2014;Jumaa et al, 2010;Shan et al, 2018;Slezak et al, 2017;Whalin et al, 2014)) available for analysis. A total of 2,129 patients underwent endovascular therapy for anterior ischemic stroke by CS, while 1,728 patients by GA.…”

mentioning

confidence: 99%

Anesthesia for endovascular treatment in anterior circulation stroke: A systematic review and meta‐analysis

et al. 2018

Brain and Behavior

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BackgroundEndovascular treatment in patients with acute anterior circulation stroke could be performed under either conscious sedation (CS) or general anesthesia (GA). Although several studies have investigated the association between the clinical outcomes and the two anesthesia methods, consensus is lacking.MethodsPubMed and EMBASE searches were used to select full‐text articles comparing the effects of GA and CS on functional outcome and complications in patients with anterior circulation ischemic stroke. Enrolled patients were assigned to receive endovascular treatment with CS or GA, with a primary outcome of functional independency within 90 days. Secondary outcomes included intracranial hemorrhage, all‐cause mortality at 90 days, pneumonia, and intraprocedural complications.ResultsThirteen studies (3 RCTs and 10 observational studies), which included 3,857 patients (CS = 2,129, GA = 1,728), were eligible for the analysis. The overall analysis including the RCTs and observational studies demonstrated that the functional independence within 90 days occurred more frequently among patients with CS compared with GA (OR, 1.42; 95% CI, 1.05–1.92, p = 0.02); and the risk of mortality was higher with GA compared with CS; furthermore, CS was associated with lower rate of intracranial hemorrhage. In RCTs, GA was associated with increased functional independence (OR, 0.55; 95% CI, 0.34–0.89, p = 0.01) and successful reperfusion (OR, 0.51; 95% CI, 0.30–0.89, p = 0.02).ConclusionsIn the overall analysis and observational studies, CS was associated with improved functional outcomes and relatively safe for anterior ischemic stroke compared with GA. While the pooled data from RCTs suggested that GA was associated with improved outcomes. The inconsistency indicated that more large‐scale RCTs are required to evaluate what factors influenced the effect of the anesthesia methods on clinical outcomes.

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General Anesthesia Versus Conscious Sedation for Endovascular Treatment of Acute Ischemic Stroke

Abstract: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01872884.

Cited by 339 publications

References 26 publications

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

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

Segabrottnám við brátt blóðþurrðarslag er mesta framför í læknisfræði í áraraðir

Anesthesia for endovascular treatment in anterior circulation stroke: A systematic review and meta‐analysis

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