Local anesthesia vs general anesthesia during endovascular therapy for acute posterior circulation stroke

Wu, Longfei; Jadhav, Ashutosh P.; Chen, Jian; Sun, Chenghe; Ji, Kangxiang; Li, Weili; Zhao, Wenbo; Li, Chuanhui; Wu, Chuanjie; Wu, Di; Ji, Xunming

doi:10.1016/j.jns.2020.117045

Cited by 13 publications

(19 citation statements)

References 29 publications

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“…Some authors have published observational data with no associations between anesthesia modality and clinical outcome. [8][9][10][11] In these studies, functional independence rates were about 32% in GA group, while mortality were between 30.4% and 42.6%. We report lower functional independence and higher mortality (19.7% and 48.2%, respectively) in an older study population (73 vs. 64 years).…”

Section: Discussionmentioning

confidence: 76%

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Impact of general anesthesia on posterior circulation large vessel occlusions after endovascular thrombectomy

Terceño

Silva

Bashir

et al. 2020

International Journal of Stroke

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Background The impact of general anesthesia on functional outcome in patients with large vessel occlusion remains unclear. Most studies have focused on anterior circulation large vessel occlusion; however, little is known about the effect of general anesthesia in patients with posterior circulation—large vessel occlusion. Methods We performed a retrospective analysis from the prospective CICAT registry. All patients with posterior circulation—large vessel occlusion—and undergoing endovascular therapy between January 2016 and January 2020 were included. Demographics, baseline characteristics, procedural data, and anesthesia modality (general anesthesia or conscious sedation) were evaluated. The primary outcome was the proportion of patients with good clinical outcome (modified Rankin Scale score of 0–2) at three months. Results 298 patients underwent endovascular treatment with posterior circulation—large vessel occlusion—were included. Age, diabetes mellitus, renal insufficiency, baseline National Institutes of Health Stroke Scale score, puncture to recanalization length, ≥3 device passes, absent of successful recanalization (defined as treatment in cerebral ischemia of 3), and general anesthesia were statistically associated with poor outcome (mRS: 3-6). In the multivariable regression, general anesthesia and ≥3 device passes were independently associated with poor outcome (aOR: 3.11, (95% CI: 1.34–7.2); P = 0.01 and 3.77, (95% CI: 1.29–11.01); P = 0.02, respectively). Patients treated with general anesthesia were less likely to have a good outcome at three months compared to conscious sedation (19.7% vs. 45.1%, P < 0.001). Conclusions In our study population, general anesthesia use is associated with poor clinical outcome in patients with posterior circulation—large vessel occlusion—treated endovascularly.

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Section: Discussionmentioning

confidence: 76%

“…[1][2][3][4][5][6][7] The few data available in patients with posterior circulation large vessel occlusion (pc-LVO) show that GA is not associated with poorer outcomes. [8][9][10][11] We aim to determine the impact of GA on the clinical outcome in these patients.…”

Section: Introductionmentioning

confidence: 99%

Impact of general anesthesia on posterior circulation large vessel occlusions after endovascular thrombectomy

Terceño

Silva

Bashir

et al. 2020

International Journal of Stroke

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“…Retrospective data differentiating subjects receiving LA without sedation from CS and GA has recently been published but individual studies have reported conflicting results for the functional outcomes between the LA, CS and GA cohorts [14][15][16][17][18][19][20][21] . Hence, the objective of this systematic and meta-analysis was to assess if LA without sedation resulted in superior procedural and clinical outcomes, compared to CS and GA, in AIS patients following EVT.…”

Section: Introductionmentioning

confidence: 99%

Local anesthesia as a distinct comparator versus conscious sedation and general anesthesia in endovascular stroke treatment: a systematic review and meta-analysis

Butt

Dhillon

Podlasek

et al. 2021

J NeuroIntervent Surg

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BackgroundThe optimal anesthetic modality for endovascular treatment (EVT) in acute ischemic stroke (AIS) is undetermined. Comparisons of general anesthesia (GA) with composite non-GA cohorts of conscious sedation (CS) and local anesthesia (LA) without sedation have provided conflicting results. There has been emerging interest in assessing whether LA alone may be associated with improved outcomes. We conducted a systematic review and meta-analysis to evaluate clinical and procedural outcomes comparing LA with CS and GA.MethodsWe reviewed the literature for studies reporting outcome variables in LA versus CS and LA versus GA comparisons. The primary outcome was 90 day good functional outcome (modified Rankin Scale (mRS) score of ≤2). Secondary outcomes included mortality, symptomatic intracerebral hemorrhage, excellent functional outcome (mRS score ≤1), successful reperfusion (Thrombolysis in Cerebral Infarction (TICI) >2b), procedural time metrics, and procedural complications. Random effects meta-analysis was performed on unadjusted and adjusted data.ResultsEight non-randomized studies of 7797 patients (2797 LA, 2218 CS, and 2782 GA) were identified. In the LA versus GA comparison, no statistically significant differences were found in unadjusted analyses for 90 day good functional outcome or mortality (OR=1.22, 95% CI 0.84 to 1.76, p=0.3 and OR=0.83, 95% CI 0.64 to 1.07, p=0.15, respectively) or in the LA versus CS comparison (OR=1.14, 95% CI 0.76 to 1.71, p=0.53 and OR=0.88, 95% CI 0.62 to 1.24, p=0.47, respectively). There was a tendency towards achieving excellent functional outcome (mRS ≤1) in the LA group versus the GA group (OR=1.44, 95% CI 1.00 to 2.08, p=0.05, I2=70%). Analysis of adjusted data demonstrated a tendency towards higher odds of death at 90 days in the GA versus the LA group (OR=1.24, 95% CI 1.00 to 1.54, p=0.05, I2=0%).ConclusionLA without sedation was not significantly superior to CS or GA in improving outcomes when performing EVT for AIS. However, the quality of the included studies impaired interpretation, and inclusion of an LA arm in future well designed multicenter, randomized controlled trials is warranted.

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“…3,8,9 Although the data in the studies included in the metaanalysis related to both neurological and non-neurological procedural complications are insufficient to be analyzed, no significant differences were observed in two of these studies when comparing GA with CS as the anesthetic approach for EVT completion. 15,19…”

Section: Discussionmentioning

confidence: 99%

“…Only some retrospective and singlecenter prospective studies have explored the effect of each anesthesia use on posterior circulation strokes. [11][12][13][14][15][16][17][18][19] Because of the low data available and the current debate on anesthesia management, we performed this meta-analysis to investigate the impact of the anesthetic approach and outcomes in patients with endovascularly treated PC-LVO.…”

Section: General Anesthesia Versus Conscious Sedation During Endovasc...mentioning

confidence: 99%

General anesthesia versus conscious sedation during endovascular treatment in posterior circulation large vessel occlusion: A systematic review and meta-analysis

Terceño

Viturro

Cienfuegos

et al. 2022

European Stroke Journal

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Purpose: The optimal anesthetic approach in the endovascular treatment (EVT) of patients with posterior circulation large vessel occlusion (PC-LVO) strokes is not clear. Little data has been published and no randomized clinical trials have been conducted so far. We aimed to perform an updated meta-analysis to compare clinical and procedural outcomes between conscious sedation (CS) and general anesthesia (GA). Methods: We reviewed the literature of the studies reporting CS and GA in patients with endovascularly-treated PC-LVO. The primary outcome was the functional outcome at 3 months measured using the modified Rankin Scale (mRS). A good functional outcome was defined as having a mRS 0–2. Secondary outcomes were mortality at 3 months, final successful recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) scale from 2b to 3) and complete recanalization (mTICI of 3) and times from stroke onset to EVT completion. Random-effects models were completed to pool the outcomes and the I2 value was calculated to assess heterogeneity. Findings: Eight studies with a total of 1351 patients were included. The pooled results reveal that CS use was associated with higher rates of good outcome (OR 2.41, 95% CI 1.58–3.64, I2 = 49.67%) and with lower mortality at 3 months (OR 0.48, 95% CI 0.28–0.82, I2 =57.11%). No significant differences were observed in the final reperfusion rates, procedural duration, and time from stroke onset to EVT completion. Conclusion: In this meta-analysis, GA was associated with significantly lower rates of functional independence at 3 months in patients with PC-LVO strokes.

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Local anesthesia vs general anesthesia during endovascular therapy for acute posterior circulation stroke

Cited by 13 publications

References 29 publications

Impact of general anesthesia on posterior circulation large vessel occlusions after endovascular thrombectomy

Impact of general anesthesia on posterior circulation large vessel occlusions after endovascular thrombectomy

Local anesthesia as a distinct comparator versus conscious sedation and general anesthesia in endovascular stroke treatment: a systematic review and meta-analysis

General anesthesia versus conscious sedation during endovascular treatment in posterior circulation large vessel occlusion: A systematic review and meta-analysis

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