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Ilyas A, Chen CJ, Ding D, Foreman PM, Buell TJ, Ironside N, Taylor DG, Kalani MY, Park MS, Southerland AM, Worrall BB. Endovascular Mechanical Thrombectomy for Acute Ischemic Stroke Under General Anesthesia Versus Conscious Sedation: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 112:e355-e367. [PMID: 29355808 DOI: 10.1016/j.wneu.2018.01.049] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Endovascular mechanical thrombectomy (EMT) is the standard of care for eligible patients presenting with anterior circulation acute ischemic stroke (AIS) due to emergent large vessel occlusion (ELVO). The aim of this systematic review and meta-analysis is to compare the outcomes between patients undergoing general anesthesia (GA) versus conscious sedation (CS) for these procedures. METHODS A literature review was performed to identify studies reporting the EMT outcomes of AIS patients who underwent GA or CS for the procedure. Baseline, treatment, and outcomes data were analyzed. Good outcome was defined as a modified Rankin Scale score of 0-2 at 3 months, and successful reperfusion was defined as modified thrombolysis in cerebral infarction grade of 2b-3. RESULTS Nine studies, comprising a total of 1379 patients treated with GA (n = 761) or CS (n = 618) for EMT, were included. Based on pooled data, GA achieved good outcome in 35% and successful reperfusion in 81%, whereas CS achieved good outcome in 41% and successful reperfusion in 75%. Meta-analyses showed no significant differences in the rates of good outcome (P = 0.51) or successful reperfusion (P = 0.39) between the GA and CS groups. The rates of pneumonia were significantly higher in the GA group (21% vs. 11%; P = 0.01). CONCLUSIONS The use of either GA or CS during EMT for patients with anterior circulation acute ELVO does not yield significantly different rates of functional independence at 3 months.
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Affiliation(s)
- Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Dale Ding
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Paul M Foreman
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Thomas J Buell
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Natasha Ironside
- Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand
| | - Davis G Taylor
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - M Yashar Kalani
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Min S Park
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Andrew M Southerland
- Department of Neurology, University of Virginia, Charlottesville, Virginia, USA; Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Bradford B Worrall
- Department of Neurology, University of Virginia, Charlottesville, Virginia, USA; Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
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Hameed A, Zafar H, Mylotte D, Sharif F. Recent Trends in Clot Retrieval Devices: A Review. Cardiol Ther 2017; 6:193-202. [PMID: 28702878 PMCID: PMC5688975 DOI: 10.1007/s40119-017-0098-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Indexed: 11/27/2022] Open
Abstract
Stroke is the second leading cause of death worldwide and in Europe. Even with gold standard medical management of acute ischemic stroke, which is intravenous (IV) thrombolysis by administration of recombinant tissue plasminogen activator (rt-PA), the mortality rate remains the same. Intra-arterial (IA) thrombolysis therapy also did not achieve significant results and was not approved by the US Food and Drug Administration (FDA) because of limited sample size. This encouraged scientists and engineers to develop endovascular clot retrieval devices for the mechanical recanalization of the occluded arteries in stroke patients. Although the initial designs of clot retrieval devices failed, efforts to improve these devices continue. Recently clot retrieval devices were approved by the FDA as first-line treatment along with IV rt-PA. This article gives an in-depth review of different clot retrieval devices which includes MERCI (the first), the Penumbra Aspiration System, EmboTrap®II, stent retrievers, and the way forward with the new FDA clearance of the devices as first-line treatment for acute ischemic stroke along with IV rt-PA. The review also includes a comparison of clot retrieval devices to gold standard treatment.
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Affiliation(s)
- Aamir Hameed
- Cardiovascular Research Centre Galway, School of Medicine, National University of Ireland Galway, Galway, Ireland
- CÚRAM, SFI Centre for Research in Medical Devices, Galway, Ireland
| | - Haroon Zafar
- Cardiovascular Research Centre Galway, School of Medicine, National University of Ireland Galway, Galway, Ireland.
- Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland.
| | - Darren Mylotte
- Cardiovascular Research Centre Galway, School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Faisal Sharif
- Cardiovascular Research Centre Galway, School of Medicine, National University of Ireland Galway, Galway, Ireland
- CÚRAM, SFI Centre for Research in Medical Devices, Galway, Ireland
- Lambe Institute for Translational Research, National University of Ireland Galway, Galway, Ireland
- Department of Cardiology, University Hospital Galway, Galway, Ireland
- BioInnovate, Galway, Ireland
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Widimsky P, Hopkins LN. Catheter-based interventions for acute ischaemic stroke. Eur Heart J 2015; 37:3081-3089. [PMID: 26429799 PMCID: PMC5091327 DOI: 10.1093/eurheartj/ehv521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/14/2015] [Indexed: 01/19/2023] Open
Abstract
Catheter-based interventions for acute ischaemic stroke currently include clot removal (usually from the medial cerebral artery) with modern stent-retrievers and in one of five patients (who have simultaneous or stand-alone internal carotid occlusion) also extracranial carotid intervention. Several recently published randomized trials clearly demonstrated superiority of catheter-based interventions (with or without bridging thrombolysis) over best medical therapy alone. The healthcare systems should adopt the new strategies for acute stroke treatment (including fast track to interventional lab) to offer the benefits to all suitable acute stroke patients.
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Affiliation(s)
- Petr Widimsky
- Cardiocenter, Third Faculty of Medicine, Charles University Prague, Srobarova 50, 100 34 Prague 10, Czech Republic
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CardioPulse ArticlesEuroPCR 2014: the 25th Official Congress of the European Association of Percutaneous Cardiovascular InterventionsPan-African Society of CardiologyFirst evidence for shockless atrial fibrillation treatmentPeople’s corner: new appointmentHighlights from EuroPCR 2014. Eur Heart J 2014; 35:2699. [DOI: 10.1093/eurheartj/ehu337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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