General anesthesia vs procedural sedation for failed NeuroThrombectomy undergoing rescue stenting: intention to treat analysis

被引：4

作者：

Mohammaden, Mahmoud H. ^{[1
,2
]}

Haussen, Diogo C. ^{[1
,2
]}

Al-Bayati, Alhamza R. ^{[3
]}

Hassan, Ameer E. ^{[4
]}

Tekle, Wondwossen ^{[4
]}

Fifi, Johanna T. ^{[5
]}

Matsoukas, Stavros ^{[5
]}

Kuybu, Okkes ^{[3
]}

Gross, Bradley A. ^{[6
]}

Lang, Michael ^{[6
]}

Narayanan, Sandra ^{[7
]}

Cortez, Gustavo M. ^{[8
]}

Hanel, Ricardo A. ^{[8
]}

Aghaebrahim, Amin ^{[8
]}

Sauvageau, Eric ^{[8
]}

Farooqui, Mudassir ^{[9
]}

Ortega-Gutierrez, Santiago ^{[10
]}

Zevallos, Cynthia B. ^{[9
]}

Galecio-Castillo, Milagros ^{[9
]}

Sheth, Sunil A. ^{[11
]}

Nahhas, Michael ^{[11
]}

Salazar-Marioni, Sergio ^{[11
]}

Nguyen, Thanh N. ^{[12
]}

Abdalkader, Mohamad ^{[13
]}

Klein, Piers ^{[12
]}

Hafeez, Muhammad ^{[14
]}

Kan, Peter ^{[15
]}

Tanweer, Omar ^{[16
]}

Khaldi, Ahmad ^{[17
]}

Li, Hanzhou ^{[18
]}

Jumaa, Mouhammad ^{[19
]}

Zaidi, Syed F. ^{[19
]}

Oliver, Marion ^{[19
]}

Salem, Mohamed ^{[20
]}

Burkhardt, Jan-Karl ^{[20
]}

Pukenas, Bryan ^{[21
]}

Kumar, Rahul ^{[22
]}

Lai, Michael ^{[22
]}

Siegler, James E. ^{[22
]}

Peng, Sophia ^{[23
]}

Alaraj, Ali ^{[23
]}

Nogueira, Raul G. ^{[3
]}

机构：

[1] Emory Univ, Neurol, Atlanta, GA USA

[2] Grady Mem Hosp, Marcus Stroke & Neurosci Ctr, Atlanta, GA USA

[3] UPMC Stroke Inst, Neurol, Pittsburgh, PA USA

[4] Univ Texas Rio Grande Valley, Neurol, Harlingen, TX USA

[5] Icahn Sch Med Mt Sinai, Neurosurg, New York, NY USA

[6] UPMC, Neurosurg, Pittsburgh, PA USA

[7] UPMC, Neurosurg, Neurol, Pittsburgh, PA USA

[8] Baptist Med Ctr Downtown, Neurosurg, Jacksonville, FL USA

[9] Univ Iowa Hosp & Clin, Neurol, Iowa City, IA 52242 USA

[10] Univ Iowa Hosp & Clin, Neurol Neurosurg & Radiol, Iowa City, IA 52242 USA

[11] Univ Texas Hlth Sci Ctr Houston, Neurol, Houston, TX 77030 USA

[12] Boston Univ, Sch Med, Neurol & Radiol, Boston, MA 02118 USA

[13] Boston Univ, Sch Med, Radiol, Boston, MA 02118 USA

[14] Baylor Coll Med, Neurosurg, Houston, TX 77030 USA

[15] Univ Texas Med Branch Galveston, Neurosurg, Galveston, TX 77555 USA

[16] Baylor Coll Med, Houston, TX 77030 USA

[17] WellStar Hlth Syst, Neurosurg, Marietta, GA USA

[18] WellStar Hlth Syst, Dept Neurosci, Marietta, GA USA

[19] Univ Toledo, Neurol, Med Ctr, Toledo, OH USA

[20] Univ Penn Hlth Syst, Neurosurg, Philadelphia, PA USA

[21] Univ Penn, Radiol, Philadelphia, PA USA

[22] Cooper Univ Hosp, Camden, NJ USA

[23] Univ Illinois, Neurosurg, Med Ctr Chicago, Chicago, IL USA

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2023年 / 15卷 / E2期

关键词：

Stroke; Angioplasty; Thrombectomy; ACUTE ISCHEMIC-STROKE; THROMBECTOMY; OCCLUSION;

D O I：

10.1136/jnis-2022-019376

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

BackgroundThere is little data available to guide optimal anesthesia management during rescue intracranial angioplasty and stenting (ICAS) for failed mechanical thrombectomy (MT). We sought to compare the procedural safety and functional outcomes of patients undergoing rescue ICAS for failed MT under general anesthesia (GA) vs non-general anesthesia (non-GA). MethodsWe searched the data from the Stenting and Angioplasty In Neuro Thrombectomy (SAINT) study. In our review we included patients if they had anterior circulation large vessel occlusion strokes due to intracranial internal carotid artery (ICA) or middle cerebral artery (MCA-M1/M2) segments, failed MT, and underwent rescue ICAS. The cohort was divided into two groups: GA and non-GA. We used propensity score matching to balance the two groups. The primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included functional independence (90-day mRS0-2) and successful reperfusion defined as mTICI2B-3. Safety measures included symptomatic intracranial hemorrhage (sICH) and 90-day mortality. ResultsAmong 253 patients who underwent rescue ICAS, 156 qualified for the matching analysis at a 1:1 ratio. Baseline demographic and clinical characteristics were balanced between both groups. Non-GA patients had comparable outcomes to GA patients both in terms of the overall degree of disability (mRS ordinal shift; adjusted common odds ratio 1.29, 95% CI [0.69 to 2.43], P=0.43) and rates of functional independence (33.3% vs 28.6%, adjusted odds ratio 1.32, 95% CI [0.51 to 3.41], P=0.56) at 90 days. Likewise, there were no significant differences in rates of successful reperfusion, sICH, procedural complications or 90-day mortality among both groups. ConclusionsNon-GA seems to be a safe and effective anesthesia strategy for patients undergoing rescue ICAS after failed MT. Larger prospective studies are warranted for more concrete evidence.

引用

页码：E240 / E247

页数：8

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