Sedation vs. Intubation for Endovascular Stroke TreAtment (SIESTA) – A Randomized Monocentric Trial

Schönenberger, Silvia; Möhlenbruch, Markus; Pfaff, Johannes; Mundiyanapurath, Sibu; Kieser, Meinhard; Bendszus, Martin; Hacke, Werner; Bösel, Julian

doi:10.1111/ijs.12488

Cited by 87 publications

(61 citation statements)

References 46 publications

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“…However, further trials are needed to clarify this benefit. 26,27 Efficient workflow, with coordination among emergency medical services, emergency departments, radiology, stroke neurology, and neurointerventionalists, needs to be optimized in order to quickly identify acute LVO, rule out large core infarcts, and appropriately transport select AIS patients to an angiography suite for endovascular thrombectomy at the earliest possible time. Policies and protocols regarding stroke systems of care will need to incorporate mechanisms for rapid triage of select AIS patients to facilities capable of providing endovascular therapy.…”

Section: Resultsmentioning

confidence: 99%

Endovascular vs medical management of acute ischemic stroke

et al. 2015

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Objective: To compare the outcomes between endovascular and medical management of acute ischemic stroke in recent randomized controlled trials (RCT).Methods: A systematic literature review was performed, and multicenter, prospective RCTs published from January 1, 2013, to May 1, 2015, directly comparing endovascular therapy to medical management for patients with acute ischemic stroke were included. Meta-analyses of modified Rankin Scale (mRS) and mortality at 90 days and symptomatic intracranial hemorrhage (sICH) for endovascular therapy and medical management were performed. Conclusions: This meta-analysis provides strong evidence that endovascular intervention combined with medical management, including IV tissue plasminogen activator for eligible patients, improves the outcomes of appropriately selected patients with acute ischemic stroke in the setting of LVO.

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Section: Resultsmentioning

confidence: 99%

Endovascular vs medical management of acute ischemic stroke

et al. 2015

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“…These findings support several retrospective analyses, suggesting that benefits of ET may be diminished or lost with the use of general anesthesia [26][27][28] . A randomized prospective trial comparing the 2 sedation methods is ongoing [29] . Many previous studies have investigated independent predictors of good outcome after intracranial thrombectomy but none of these were specifically for patients with TOs.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Acute Ischemic Stroke Due to Tandem Occlusions: Large Multicenter Series and Systematic Review

Grigoryan

Haussen

Hassan³

et al. 2016

Cerebrovasc Dis

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Background: Ischemic strokes due to tandem occlusions (TOs) have poor outcomes if they have been treated with only medical interventions. Recent trials demonstrated the effectiveness of endovascular treatment of acute ischemic stroke due to intracranial occlusions; however, most studies excluded patients with TOs. Methods: Retrospective review of prospectively collected thrombectomy databases from 3 stroke centers between 2011 and 2015. Consecutive patients with tandem extracranial steno-occlusive carotid disease and intracranial occlusions who underwent emergent thrombectomy were selected. Angiographic and clinical outcomes were analyzed; baseline and procedural variables were included in univariate and multivariate analyses to define the independent predictors of good outcomes (90-day modified Rankin Scale ≤2). Results: A total of 100 patients met the study inclusion criteria. The mean age was 64.4 ± 12.5, baseline National Institutes of Health Stroke Scale (NIHSS) 17.6 ± 5.0, time from last known well to puncture 7.3 ± 5.8 h, and Alberta Stroke Program Early CT Score (ASPECTS) 7.5 ± 1.6. Forty percent received intravenous tissue plasminogen activator. Intracranial occlusion sites included: internal carotid artery thrombus, 31%; middle cerebral artery (MCA)-M1, 53%; MCA-M2, 10%; and anterior cerebral artery, 6%. Good outcome was achieved in 42% and successful reperfusion modified thrombolysis in cerebral infarction (mTICI ≥2B) in 88% of the cases, including complete (mTICI 3) reperfusion in 40%. Severe parenchymal hematoma (PH)-2 occurred in 6% of the patients and 90-day mortality was 20%. In the multivariate analysis, younger age (OR 0.93; 95% CI 0.88-0.98; p = 0.004), lower baseline NIHSS (OR 0.84; 95% CI 0.74-0.94; p = 0.003), higher ASPECTS (OR 1.50; 95% CI 1.02-2.19; p = 0.038), and mTICI 3 reperfusion (OR 3.56; 95% CI 1.18-10.76; p = 0.024) were independent predictors of good outcome at 90 days. Conclusions: Acute endovascular treatment of tandem anterior circulation occlusions yields good outcomes and has similar outcome predictors to isolated intracranial occlusions. Given their comparable clinical behavior, these patients should be included in future trials.

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“…50 The issue of general anesthesia vs. sedation is currently studied in four randomized trials (ANSTROKE, COMET, GOLIATH and SIESTA). [51][52][53][54] An expert consensus statement of the Society of Neurointerventional Surgery and the Neurocritical Care Society recommends the use of general anesthesia for patients with severe agitation, low level of consciousness (GCS < 8), loss of airway protective reflexes, respiratory compromise and in selected posterior circulation stroke presenting with these features. 55 Prehospital patient selection for immediate transfer to centers with multimodal imaging and availability of thrombectomy.…”

Section: Aspects To Be Considered In Mechanical Thrombectomymentioning

confidence: 99%

Mechanical thrombectomy in acute ischemic stroke: Consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN

Wahlgren

Moreira

Michel³

et al. 2015

International Journal of Stroke

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327

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The original version of this consensus statement on mechanical thrombectomy was approved at the European Stroke Organisation (ESO)-Karolinska Stroke Update conference in Stockholm, 16-18 November 2014. The statement has later, during 2015, been updated with new clinical trials data in accordance with a decision made at the conference. Revisions have been made at a face-to-face meeting during the ESO Winter School in Berne in February, through email exchanges and the final version has then been approved by each society. The recommendations are identical to the original version with evidence level upgraded by 20 February 2015 and confirmed by 15 May 2015. The purpose of the ESO-Karolinska Stroke Update meetings is to provide updates on recent stroke therapy research and to discuss how the results may be implemented into clinical routine. Selected topics are discussed at consensus sessions, for which a consensus statement is prepared and discussed by the participants at the meeting. The statements are advisory to the ESO guidelines committee. This consensus statement includes recommendations on mechanical thrombectomy after

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Sedation vs. Intubation for Endovascular Stroke TreAtment (SIESTA) – A Randomized Monocentric Trial

Cited by 87 publications

References 46 publications

Endovascular vs medical management of acute ischemic stroke

Endovascular vs medical management of acute ischemic stroke

Endovascular Treatment of Acute Ischemic Stroke Due to Tandem Occlusions: Large Multicenter Series and Systematic Review

Mechanical thrombectomy in acute ischemic stroke: Consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN

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