The effect of anesthetic management during intra-arterial therapy for acute stroke in MR CLEAN

被引：119

作者：

Berkhemer, Olvert A. ^{[1
,5
]}

van den Berg, Lucie A. ^{[2
]}

Fransen, Puck S. S. ^{[4
,5
]}

Beumer, Debbie ^{[8
]}

Yoo, Albert J. ^{[9
]}

Lingsma, Hester F. ^{[6
]}

Schonewille, Wouter J. ^{[10
]}

van den Berg, Rene ^{[1
]}

Wermer, Marieke J. H. ^{[11
]}

Boiten, Jelis ^{[12
]}

Nijeholt, Geert J. Lycklama ^{[13
]}

Nederkoorn, Paul J. ^{[2
]}

Hollmann, Markus W. ^{[3
]}

van Zwam, Wim H. ^{[7
]}

van der Lugt, Aad ^{[4
]}

van Oostenbrugge, Robert J. ^{[8
]}

Majoie, Charles B. L. M. ^{[1
]}

Dippel, Diederik W. J. ^{[5
]}

Roos, Yvo B. W. E. M. ^{[2
]}

机构：

[1] Acad Med Ctr, Dept Radiol, Amsterdam, Netherlands

[2] Acad Med Ctr, Dept Neurol, Amsterdam, Netherlands

[3] Acad Med Ctr, Dept Anesthesiol, Amsterdam, Netherlands

[4] Erasmus MC Univ Med Ctr, Dept Radiol, Rotterdam, Netherlands

[5] Erasmus MC Univ Med Ctr, Dept Neurol, Rotterdam, Netherlands

[6] Erasmus MC Univ Med Ctr, Dept Publ Hlth, Rotterdam, Netherlands

[7] Maastricht Univ, Med Ctr, Dept Radiol, NL-6200 MD Maastricht, Netherlands

[8] Maastricht Univ, Med Ctr, Dept Neurol, NL-6200 MD Maastricht, Netherlands

[9] Texas Stroke Inst, Div Neurointervent, Plano, TX USA

[10] St Antonius Hosp, Dept Neurol, Nieuwegein, Netherlands

[11] Leiden Univ, Med Ctr, Dept Neurol, NL-2300 RA Leiden, Netherlands

[12] MC Haaglanden, Dept Neurol, The Hague, Netherlands

[13] MC Haaglanden, Dept Radiol, The Hague, Netherlands

来源：

NEUROLOGY | 2016年 / 87卷 / 07期

关键词：

ACUTE ISCHEMIC-STROKE; ENDOVASCULAR TREATMENT; GENERAL-ANESTHESIA; CONSENSUS STATEMENT; TRIAL; THROMBECTOMY; HYPOTENSION; INTUBATION; OUTCOMES; SAFETY;

D O I：

10.1212/WNL.0000000000002976

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: The aim of the current study was to assess the influence of anesthetic management on the effect of treatment in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN). Methods: MR CLEAN was amulticenter, randomized, open-label trial of intra-arterial therapy (IAT) vs no IAT. The intended anesthetic management at the start of the procedure was used for this post hoc analysis. The primary effect parameter was the adjusted common odds ratio (acOR) for a shift in direction of a better outcome on the modified Rankin Scale (mRS) at 90 days, estimated with multivariable ordinal logistic regression analysis, which included a term for general anesthesia (GA). Results: GA was associated with significant (p=0.011) effect modification, resulting in estimated decrease of 51%(95% confidence interval [CI] 31%-86%) in treatment effect compared to non-GA. We found a shift in the distribution on the mRS in favor of non-GA compared to control group (acOR 2.18 [95% CI 1.49-3.20]). The shift in distribution between GA and control group was in a similar direction (acOR 1.12 [95% CI 0.71-1.78]) with loss of statistical significance. Conclusions: In this post hoc analysis, we found that the type of anesthetic management influences outcome following IAT. Only treatment without general anesthesia was associated with a significant treatment benefit in MR CLEAN. Classification of evidence: This study provides Class II evidence that for patients with acute ischemic stroke undergoing IAT, mRS scores at 90 days improve only in patients treated without GA.

引用

页码：656 / 664

页数：9

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