Association between anesthesia modality and clinical outcomes following endovascular stroke treatment in the extended time window

被引:4
作者
Dhillon, Permesh Singh [1 ,2 ,3 ]
Butt, Waleed [4 ]
Podlasek, Anna [5 ]
McConachie, Norman [1 ]
Lenthall, Robert [1 ]
Nair, Sujit [1 ]
Malik, Luqman [1 ]
Hewson, David W. [6 ]
Bhogal, Pervinder [7 ]
Makalanda, Hegoda Levansri Dilrukshan [7 ]
James, Martin A. [8 ,9 ,10 ]
Dineen, Robert A. [11 ]
England, Timothy J. [3 ,12 ]
机构
[1] Nottingham Univ Hosp NHS Trust, Intervent Neuroradiol, Nottingham, England
[2] NIHR Nottingham Biomed Res Ctr, Nottingham, England
[3] Univ Nottingham, Sch Med, Stroke Trials Unit, Mental Hlth & Clin Neurosci, Nottingham, England
[4] Univ Hosp Birmingham NHS Trust, Intervent Neuroradiol, Birmingham, W Midlands, England
[5] Univ Dundee, Tayside Innovat Medtech Ecosyst TIME, Dundee, Scotland
[6] Univ Nottingham, Fac Med & Hlth Sci, Acad Unit Injury Inflammat & Recovery Sci, Anaesthesia & Crit Care Res Grp, Nottingham, England
[7] Barts Hlth NHS Trust, Intervent Neuroradiol, London, England
[8] Univ Exeter, Exeter Med Sch, Med Sch, Exeter, Devon, England
[9] Royal Devon & Exeter NHS Fdn Trust, Stroke, Exeter, Devon, England
[10] Kings Coll London, Sentinel Stroke Natl Audit Programme, London, England
[11] Univ Nottingham, Radiol Sci Mental Hlth & Clin Neurosci, Nottingham, England
[12] Univ Hosp Derby & Burton NHS Fdn Trust, Stroke, Nottingham, England
关键词
Blood Pressure; Intervention; Stroke; Thrombectomy; ACUTE ISCHEMIC-STROKE; CONSCIOUS SEDATION; GENERAL-ANESTHESIA; BLOOD-PRESSURE; THROMBECTOMY;
D O I
10.1136/neurintsurg-2022-018846
中图分类号
R445 [影像诊断学];
学科分类号
100207 ;
摘要
Background There is a paucity of data on anesthesia-related outcomes for endovascular treatment (EVT) in the extended window (>6 hours from ischemic stroke onset). We compared functional and safety outcomes between local anesthesia (LA) without sedation, conscious sedation (CS) and general anesthesia (GA). Methods Patients who underwent EVT in the early (<6 hours) and extended time windows using LA, CS, or GA between October 2015 and March 2020 were included from a UK national stroke registry. Multivariable analyses were performed, adjusted for age, sex, baseline stroke severity, pre-stroke disability, EVT technique, center, procedural time and IV thrombolysis. Results A total of 4337 patients were included, 3193 in the early window (1135 LA, 446 CS, 1612 GA) and 1144 in the extended window (357 LA, 134 CS, 653 GA). Compared with GA, patients treated under LA alone had increased odds of an improved modified Rankin Scale (mRS) score at discharge (early: adjusted common (ac) OR=1.50, 95% CI 1.29 to 1.74, p=0.001; extended: acOR=1.29, 95% CI 1.01 to 1.66, p=0.043). Similar mRS scores at discharge were found in the LA and CS cohorts in the early and extended windows (p=0.21). Compared with CS, use of GA was associated with a worse mRS score at discharge in the early window (acOR=0.73, 95% CI 0.45 to 0.96, p=0.017) but not in the extended window (p=0.55). There were no significant differences in the rates of symptomatic intracranial hemorrhage or in-hospital mortality across the anesthesia modalities in the extended window. Conclusion LA without sedation during EVT was associated with improved functional outcomes compared with GA, but not CS, within and beyond 6 hours from stroke onset. Prospective studies assessing anesthesia-related outcomes in the extended time window are warranted.
引用
收藏
页码:478 / +
页数:6
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