Stroke thrombectomy perioperative anesthetic and hemodynamic management

Farag, Ehab; Argalious, Maged; Tóth, Gábor

doi:10.1136/neurintsurg-2021-018300

Cited by 4 publications

(2 citation statements)

References 43 publications

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“…This includes not only whether general anesthesia (GA) or monitored anesthesia care (MAC) is preferable, but also blood pressure measurement/parameters/treatment options. Farag et al 1 provided an updated review on this topic. They concisely reviewed randomized controlled trials evaluating MAC versus GA, including the SIESTA (Sedation vs Intubation for Endovascular Stroke Treatment),2 ANSTROKE (Anesthesia During Stroke),3 and GOLIATH (General or Local Anesthesia in Intra Arterial Therapy)4 trials.…”

Section: Stroke Thrombectomy Perioperative Anesthetic and Hemodynamic...mentioning

confidence: 99%

JNISspotlight: commissioned reviews

Chen

2023

J NeuroIntervent Surg

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Section: Stroke Thrombectomy Perioperative Anesthetic and Hemodynamic...mentioning

confidence: 99%

JNISspotlight: commissioned reviews

Chen

2023

J NeuroIntervent Surg

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“…Although alternative sedation protocols have been emphasized to be considered over general anesthesia (GA) during thrombectomy [ 5 ], and periprocedural conscious sedation concepts have been associated with improved functional outcome [ 5 ], there is still a notable number of LVO patients who receive GA in order to minimize procedural risk, e.g., patients with aphasia-associated limited comprehension. Furthermore, especially in more severely affected patients with initial impairment of consciousness, GA may still be necessary, and patients may stay on ventilator support for some time after endovascular treatment (EVT) [ 6 , 7 ] particularly in those cases when complications like BE are expected due to long time-windows or absent recanalization success. Thus, several LVO patients may stay on ventilator support for some time after EVT [ 6 ], complicating clinical evaluation.…”

Section: Introductionmentioning

confidence: 99%

Pupillometry in the follow-up of patients undergoing EVT - prediction of space-occupying hemispheric infarction

Kossel,

Kobus,

Borutta

et al. 2023

J Neurol

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Background Despite benefits of endovascular treatment (EVT) for large vessel occlusion (LVO) ischemic stroke, space-occupying brain edema (BE) represents a detrimental complication. In critical-care settings, CT-imaging is needed for monitoring these patients. Yet, bed-side techniques with the potential to predict whether patients develop BE or not would facilitate a time- and cost-efficient patient care. We assessed clinical significance of automated pupillometry in the follow-up of patients undergoing EVT. Methods From 10/2018 to 10/2021, neurocritical-care-unit patients were retrospectively enrolled after EVT of anterior circulation LVO. We monitored parameters of pupillary reactivity [light-reflex-latency (Lat), constriction- and redilation-velocities (CV, DV), percentage-change-of-apertures (per-change); NeurOptics-pupilometer®] up to every hour on day 1–3 of ICU stay. BE was defined as midline shift ≥ 5 mm on follow-up imaging 3–5 days after EVT. We calculated mean values of intra-individual differences between successive pairs of parameters (mean-deltas), determined best discriminative cut-off values for BE development (ROC-analyses), and evaluated prognostic performance of pupillometry for BE development (sensitivity/specificity/positive-/negative-predictive-values). Results 3241 pupillary assessments of 122 patients [67 women, 73 years (61.0–85.0)] were included. 13/122 patients developed BE. Patients with BE had significantly lower CVs, DVs, and smaller per-changes than patients without BE. On day 1 after EVT mean-deltas of CV, DV, and per-changes were significantly lower in patients with than without BE. Positive-predictive-values of calculated thresholds to discriminate both groups were considerably low, yet, we found high negative-predictive-values for CV, DV, per-changes, and mean-deltas (max.: 98.4%). Conclusion Our data suggest associations between noninvasively detected changes in pupillary reactivity and BE early after LVO-EVT. Pupillometry may identify patients who are unlikely to develop BE and may not need repetitive follow-up-imaging or rescue-therapy.

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Neuroprotection during Thrombectomy for Acute Ischemic Stroke: A Review of Future Therapies

Dammavalam,

Lin,

Nessa

et al. 2024

IJMS

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Stroke is a major cause of death and disability worldwide. Endovascular thrombectomy has been impactful in decreasing mortality. However, many clinical results continue to show suboptimal functional outcomes despite high recanalization rates. This gap in recanalization and symptomatic improvement suggests a need for adjunctive therapies in post-thrombectomy care. With greater insight into ischemia-reperfusion injury, recent preclinical testing of neuroprotective agents has shifted towards preventing oxidative stress through upregulation of antioxidants and downstream effectors, with positive results. Advances in multiple neuroprotective therapies, including uric acid, activated protein C, nerinetide, otaplimastat, imatinib, verapamil, butylphthalide, edaravone, nelonemdaz, ApTOLL, regional hypothermia, remote ischemic conditioning, normobaric oxygen, and especially nuclear factor erythroid 2-related factor 2, have promising evidence for improving stroke care. Sedation and blood pressure management in endovascular thrombectomy also play crucial roles in improved stroke outcomes. A hand-in-hand approach with both endovascular therapy and neuroprotection may be the key to targeting disability due to stroke.

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Stroke thrombectomy perioperative anesthetic and hemodynamic management

Cited by 4 publications

References 43 publications

JNISspotlight: commissioned reviews

JNISspotlight: commissioned reviews

Pupillometry in the follow-up of patients undergoing EVT - prediction of space-occupying hemispheric infarction

Neuroprotection during Thrombectomy for Acute Ischemic Stroke: A Review of Future Therapies

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