General anesthesia or conscious sedation for endovascular therapy of basilar artery occlusions: ETIS registry results - 05/10/22
, A. Consoli e, B. Lapergue f, R. Blanc g, R. Bourcier h, I. Sibon j, F. Eugène k, S. Vannier l, C. Dargazanli m, C. Arquizan n, R. Anxionnat b, c, S. Richard o, p, R. Fahed q, G. Marnat i, B. Gory b, con behalf of the
Endovascular Treatment in Ischemic Stroke (ETIS) Investigators1
Highlights |
• | The best anesthetic management during endovascular therapy for stroke patients with acute basilar artery occlusion is unknown. |
• | In the present retrospective analysis of the ongoing multicenter observational Endovascular Treatment In Ischemic Stroke Registry including 524 consecutive basilar artery occlusion who had EVT indication from January 1st, 2015, to December 31st, 2021, 266 had general anesthesia and 246 had conscious sedation/local anesthesia (67 local anesthesia). After matching, two groups of 129 patients each underwent primary analysis. |
• | Whereas 15 patients (5.9%) in the general anesthesia group and 38 patients (16.1%, P < 0.001) in the conscious sedation/local anesthesia group were not treated with endovascular treatment, both groups demonstrated similar results regarding procedural time, quality of reperfusion, symptomatic intracranial hemorrhage and 90-day clinical outcome. |
• | The safety, quality of endovascular treatment, and clinical outcome either under general anesthesia or conscious sedation appear to be similar but stress the need for a randomized trial. |
Abstract |
Background and purpose |
Acute basilar artery occlusions (BAO) are associated with poor outcome despite modern endovascular treatment (EVT). The best anesthetic management during EVT is not known and may affect the procedure and clinical outcome. We compared the efficacy and safety of general anesthesia (GA) and conscious sedation/local anesthesia (CS/LA) in a large cohort of stroke patients with BAO treated with EVT in current clinical practice.
Methods |
Data from the ongoing prospective multicenter Endovascular Treatment In Ischemic Stroke Registry of consecutive acute BAO patients who had EVT indication from January 1st, 2015, to December 31st, 2021, were retrospectively analyzed. Two groups were compared: patients treated with CS/LA versus GA (both types of anesthesia being performed in the angiosuite). Good outcome was defined as modified Rankin Scale (mRS) score 0–3 at 90 days.
Results |
Among the 524 included patients, 266 had GA and 246 had CS/LA (67 LA). Fifty-three patients finally did not undergo EVT: 15 patients (5.9%) in the GA group and 38 patients (16.1%) in the CS/LA group (P < 0.001). After matching, two groups of 129 patients each were retained for primary analysis. The two groups were well balanced in terms of baseline characteristics. After adjustment, CS/LA compared to GA was not associated with good outcome (OR=0.90 [95%CI 0.46–1.77] P=0.769) or mortality (OR=0.75 [0.37–1.49] P=0.420) or modified thrombolysis in cerebral infarction score 2b-3 (OR=0.43 [0.16–1.16] P=0.098). On mixed ordinal logistic regression, the modality of anesthesia was not associated with any significant change in the overall distribution of the 90-day mRS (adjusted OR=1.08 [0.62–1.88] P=0.767).
Conclusions |
Safety, outcome and quality of EVT under either CS/LA or GA for stroke due to acute BAO appear similar. Further randomized trials are warranted.
Le texte complet de cet article est disponible en PDF.Keywords : Stroke, Basilar artery occlusion, Posterior circulation, Endovascular treatment, Anesthesia
Plan
Vol 178 - N° 8
P. 771-779 - octobre 2022 Retour au numéro
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