1. Endovascular Treatment for Acute Ischemic Stroke With or Without General Anesthesia: A Matched Comparison
- Author
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Benjamin Wagner, Johannes Lorscheider, Andrea Wiencierz, Kristine Blackham, Marios Psychogios, Daniel Bolliger, Gian Marco De Marchis, Stefan T. Engelter, Philippe Lyrer, Patrick R. Wright, Urs Fischer, Pasquale Mordasini, Stefania Nannoni, Francesco Puccinelli, Timo Kahles, Giovanni Bianco, Emmanuel Carrera, Andreas R. Luft, Carlo W. Cereda, Georg Kägi, Johannes Weber, Krassen Nedeltchev, Patrik Michel, Jan Gralla, Marcel Arnold, Leo H. Bonati, Javier Anon, Sandra Clarke, Michael Diepers, Philipp Gruber, Eileen Martin, Luca Remonda, Andreas Schweikert, Vedrana Zupa., Valerian Altersberger, Alex Brehm, Tolga Dittrich, Amgad El Mekabaty, Joachim Fladt, Urs Fisch, Henrik Gensicke, Lisa Hert, Sabrina Manuzzi, Marina Maurer, Louisa Meya, Nils Peters, Alexandros Polymeris, Sebastian Thilemann, Christopher Traenka, Ioannes Tsogkas, Anaelle Zietz, Martina Goeldlin, Mirjam Heldner, Simon Jung, Johannes Kaesmacher, Basel Mamaari, Thomas Meinel, Madlaine Mueller, Hakan Sarykaya, David Seiffge, Bernhard Siepen, Jan Vynkier, Ashraf Eskandari, Vasiliki Pantazou, Davide Strambo, Jane Frangi, Shairin Sihabdeen, Jochen Vehoff, Mira Katan, Achim Mueller, and Susanne Wegener
- Subjects
Advanced and Specialized Nursing ,Stroke ,Treatment Outcome ,Endovascular Procedures ,Humans ,Neurology (clinical) ,Anesthesia, General ,Cardiology and Cardiovascular Medicine ,Intracranial Hemorrhages ,United States ,Brain Ischemia ,Ischemic Stroke - Abstract
Background: Endovascular treatment in large artery occlusion stroke reduces disability. However, the impact of anesthesia type on clinical outcomes remains uncertain. Methods: We compared consecutive patients in the Swiss Stroke Registry with anterior circulation stroke receiving endovascular treatment with or without general anesthesia (GA). The primary outcome was disability on the modified Rankin Scale after 3 months, analyzed with ordered logistic regression. Secondary outcomes included dependency or death (modified Rankin Scale score ≥ 3), National Institutes of Health Stroke Scale after 24 hours, symptomatic intracranial hemorrhage with ≥ 4 points worsening on National Institutes of Health Stroke Scale within 7 days, and mortality. Coarsened exact matching and propensity score matching were performed to adjust for indication bias. Results: One thousand two hundred eighty-four patients (GA: n=851, non-GA: n=433) from 8 Stroke Centers were included. Patients treated with GA had higher modified Rankin Scale scores after 3 months than patients treated without GA, in the unmatched (odds ratio [OR], 1.75 [1.42–2.16]; P P =0.020), and the propensity score matching analysis (n=568; OR, 1.61 [1.20–2.15]; P =0.001). In the coarsened exact matching analysis, there were no significant differences in National Institutes of Health Stroke Scale after 1 day (estimated coefficient 2.61 [0.59–4.64]), symptomatic intracranial hemorrhage (OR, 1.06 [0.30–3.75]), dependency or death (OR, 1.42 [0.91–2.23]), or mortality (OR, 1.65 [0.94–2.89]). In the propensity score matching analysis, National Institutes of Health Stroke Scale after 24 hours (estimated coefficient, 3.40 [1.76–5.04]), dependency or death (OR, 1.49 [1.07–2.07]), and mortality (OR, 1.65 [1.11–2.45]) were higher in the GA group, whereas symptomatic intracranial hemorrhage did not differ significantly (OR, 1.77 [0.73–4.29]). Conclusions: This large study showed worse functional outcome after endovascular treatment of anterior circulation stroke with GA than without GA in a real-world setting. This finding appears to be independent of known differences in patient characteristics between groups.
- Published
- 2022