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Wang X, Wu Y, Liang F, Gu H, Jian M, Wang Y, Liu H, Han R. General anesthesia versus nongeneral anesthesia during endovascular therapy for acute ischemic stroke: A systematic review and meta-analysis. J Evid Based Med 2023; 16:477-484. [PMID: 38130029 DOI: 10.1111/jebm.12569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This study compares the safety and efficacy of general anesthesia (GA) and nongeneral anesthesia (non-GA) on functional outcomes in patients receiving endovascular therapy for ischemic stroke. METHODS All available studies on the anesthetic management of patients with acute ischemic stroke in PubMed, the Cochrane Central Register of Controlled Trials, and Embase were included. We also compared the clinical outcomes in the studies with subgroup analyses of the occlusion site (anterior vs. posterior circulation) and preretriever group versus retriever group. Functional independence, mortality, successful recanalization, hemodynamic instability, intracerebral hemorrhage, and respiratory complications were considered primary or secondary outcomes. RESULTS A total of 24,606 patients in 60 studies were included. GA had a lower risk of 90-day functional independence (OR = 0.67, 95% CI 0.58 to 0.77), higher risk of 90-day mortality (OR = 1.29; 95% CI 1.15 to 1.45), and successful reperfusion (OR = 1.18; 95% CI 1.94 to 6.82). However, there were no differences in functional independence and mortality between GA and non-GA at 90 days after the procedure. CONCLUSION The study shows poorer results in the GA group, which may be due to the inclusion of nonrandomized studies. However, analysis of the RCTs suggested that the outcomes do not differ between the two groups (GA vs. non-GA). Thus, general anesthesia is as safe as nongeneral anesthesia under standardized management.
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Affiliation(s)
- Xinyan Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxuan Wu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fa Liang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongqiu Gu
- Department of Statistics, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Minyu Jian
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunzhen Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haiyang Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ruquan Han
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Geraldini F, Diana P, Fregolent D, De Cassai A, Boscolo A, Pettenuzzo T, Sella N, Lupelli I, Navalesi P, Munari M. General anesthesia or conscious sedation for thrombectomy in stroke patients: an updated systematic review and meta-analysis. Can J Anaesth 2023; 70:1167-1181. [PMID: 37268801 DOI: 10.1007/s12630-023-02481-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 06/04/2023] Open
Abstract
PURPOSE Endovascular treatment for stroke patients usually requires anesthesia care, with no current consensus on the best anesthetic management strategy. Several randomized controlled trials and meta-analyses have attempted to address this. In 2022, additional evidence from three new trials was published: the GASS trial, the CANVAS II trial, and preliminary results from the AMETIS trial, prompting the execution of this updated systematic review and meta-analysis. The primary objective of this study was to evaluate the effects of general anesthesia and conscious sedation on functional outcomes measured with the modified Rankin scale (mRS) at three months. METHODS We performed a systematic review and meta-analysis of randomized controlled trials investigating conscious sedation and general anesthesia in endovascular treatment. The following databases were examined: PubMed, Scopus, Embase, and the Cochrane Database of Randomized Controlled Trials and Systematic Reviews. The Risk of Bias 2 tool was used to assess bias. In addition, trial sequence analysis was performed on the primary outcome to estimate if the cumulative effect is significant enough to be unaffected by further studies. RESULTS Nine randomized controlled trials were identified, including 1,342 patients undergoing endovascular treatment for stroke. No significant differences were detected between general anesthesia and conscious sedation with regards to mRS, functional independence (mRS, 0-2), procedure duration, onset to reperfusion, mortality, hospital length of stay, and intensive care unit length of stay. Patients treated under general anesthesia may have more frequent successful reperfusion, though the time from groin to reperfusion was slightly longer. Trial sequential analysis showed that additional trials are unlikely to show marked differences in mean mRS at three months. CONCLUSIONS In this updated systematic review and meta-analysis, the choice of anesthetic strategy for endovascular treatment of stroke patients did not significantly impact functional outcome as measured with the mRS at three months. Patients managed with general anesthesia may have more frequent successful reperfusion. TRIAL REGISTRATION PROSPERO (CRD42022319368); registered 19 April 2022.
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Affiliation(s)
- Federico Geraldini
- UOC Anesthesia and Intensive Care Unit, Institute of Anesthesia and Intensive Care, Padua University Hospital, Via Giustiniani 1, 35127, Padua, Italy
| | - Paolo Diana
- UOC Anesthesia and Intensive Care Unit, Institute of Anesthesia and Intensive Care, Padua University Hospital, Via Giustiniani 1, 35127, Padua, Italy
| | | | - Alessandro De Cassai
- UOC Anesthesia and Intensive Care Unit, Institute of Anesthesia and Intensive Care, Padua University Hospital, Via Giustiniani 1, 35127, Padua, Italy
| | - Annalisa Boscolo
- UOC Anesthesia and Intensive Care Unit, Institute of Anesthesia and Intensive Care, Padua University Hospital, Via Giustiniani 1, 35127, Padua, Italy
| | - Tommaso Pettenuzzo
- UOC Anesthesia and Intensive Care Unit, Institute of Anesthesia and Intensive Care, Padua University Hospital, Via Giustiniani 1, 35127, Padua, Italy
| | - Nicolò Sella
- UOC Anesthesia and Intensive Care Unit, Institute of Anesthesia and Intensive Care, Padua University Hospital, Via Giustiniani 1, 35127, Padua, Italy
| | - Irene Lupelli
- Department of Medicine, University of Padua, Padua, Italy
| | - Paolo Navalesi
- UOC Anesthesia and Intensive Care Unit, Institute of Anesthesia and Intensive Care, Padua University Hospital, Via Giustiniani 1, 35127, Padua, Italy
- Department of Medicine, University of Padua, Padua, Italy
| | - Marina Munari
- UOC Anesthesia and Intensive Care Unit, Institute of Anesthesia and Intensive Care, Padua University Hospital, Via Giustiniani 1, 35127, Padua, Italy
- Neurointensive Care Unit, Padua University Hospital, Padua, Italy
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Amini M, van Leeuwen N, Eijkenaar F, van de Graaf R, Samuels N, van Oostenbrugge R, van den Wijngaard IR, van Doormaal PJ, Roos YBWEM, Majoie C, Roozenbeek B, Dippel D, Burke J, Lingsma HF, Dippel DWJ, van der Lugt A, Majoie CBLM, Roos YBWEM, van Oostenbrugge RJ, van Zwam WH, Boiten J, Vos JA, Brouwer J, den Hartog SJ, Hinsenveld WH, Kappelhof M, Compagne KCJ, Goldhoorn RJB, Mulder MJHL, Jansen IGH, Dippel DWJ, Roozenbeek B, van der Lugt A, van Es ACGM, Majoie CBLM, Roos YBWEM, Emmer BJ, Coutinho JM, Schonewille WJ, Vos JA, Wermer MJH, van Walderveen MAA, Staals J, van Oostenbrugge RJ, van Zwam WH, Hofmeijer J, Martens JM, Lycklama à Nijeholt GJ, Boiten J, de Bruijn SF, van Dijk LC, van der Worp HB, Lo RH, van Dijk EJ, Boogaarts HD, de Vries J, de Kort PLM, van Tuijl J, Peluso JJP, Fransen P, van den Berg JSP, van Hasselt BAAM, Aerden LAM, Dallinga RJ, Uyttenboogaart M, Eschgi O, Bokkers RPH, Schreuder THCML, Heijboer RJJ, Keizer K, Yo LSF, den Hertog HM, Sturm EJC, Brouwers P, Majoie CBLM, van Zwam WH, van der Lugt A, Lycklama à Nijeholt GJ, van Walderveen MAA, Sprengers MES, Jenniskens SFM, van den Berg R, Yoo AJ, Beenen LFM, Postma AA, Roosendaal SD, van der Kallen BFW, van den Wijngaard IR, van Es ACGM, Emmer BJ, Martens JM, Yo LSF, Vos JA, Bot J, van Doormaal PJ, Meijer A, Ghariq E, Bokkers RPH, van Proosdij MP, Krietemeijer GM, Peluso JP, Boogaarts HD, Lo R, Gerrits D, Dinkelaar W, Appelman APA, Hammer B, Pegge S, van der Hoorn A, Vinke S, Dippel DWJ, van der Lugt A, Majoie CBLM, Roos YBWEM, van Oostenbrugge RJ, van Zwam WH, Lycklama à Nijeholt GJ, Boiten J, Vos JA, Schonewille WJ, Hofmeijer J, Martens JM, van der Worp HB, Lo RH, van Oostenbrugge RJ, Hofmeijer J, Flach HZ, Lingsma HF, el Ghannouti N, Sterrenberg M, Puppels C, Pellikaan W, Sprengers R, Elfrink M, Simons M, Vossers M, de Meris J, Vermeulen T, Geerlings A, van Vemde G, Simons T, van Rijswijk C, Messchendorp G, Nicolaij N, Bongenaar H, Bodde K, Kleijn S, Lodico J, Droste H, Wollaert M, Verheesen S, Jeurrissen D, Bos E, Drabbe Y, Sandiman M, Elfrink M, Aaldering N, Zweedijk B, Khalilzada M, Vervoort J, Droste H, Nicolaij N, Simons M, Ponjee E, Romviel S, Kanselaar K, Bos E, Barning D, Venema E, Chalos V, Geuskens RR, van Straaten T, Ergezen S, Harmsma RRM, Muijres D, de Jong A, Berkhemer OA, Boers AMM, Huguet J, Groot PFC, Mens MA, van Kranendonk KR, Treurniet KM, Jansen IGH, Tolhuisen ML, Alves H, Weterings AJ, Kirkels ELF, Voogd EJHF, Schupp LM, Collette S, Groot AED, LeCouffe NE, Konduri PR, Prasetya H, Arrarte-Terreros N, Ramos LA. Estimation of treatment effects in observational stroke care data: comparison of statistical approaches. BMC Med Res Methodol 2022; 22:103. [PMID: 35399057 PMCID: PMC8996562 DOI: 10.1186/s12874-022-01590-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Various statistical approaches can be used to deal with unmeasured confounding when estimating treatment effects in observational studies, each with its own pros and cons. This study aimed to compare treatment effects as estimated by different statistical approaches for two interventions in observational stroke care data.
Patients and methods
We used prospectively collected data from the MR CLEAN registry including all patients (n = 3279) with ischemic stroke who underwent endovascular treatment (EVT) from 2014 to 2017 in 17 Dutch hospitals. Treatment effects of two interventions – i.e., receiving an intravenous thrombolytic (IVT) and undergoing general anesthesia (GA) before EVT – on good functional outcome (modified Rankin Scale ≤2) were estimated. We used three statistical regression-based approaches that vary in assumptions regarding the source of unmeasured confounding: individual-level (two subtypes), ecological, and instrumental variable analyses. In the latter, the preference for using the interventions in each hospital was used as an instrument.
Results
Use of IVT (range 66–87%) and GA (range 0–93%) varied substantially between hospitals. For IVT, the individual-level (OR ~ 1.33) resulted in significant positive effect estimates whereas in instrumental variable analysis no significant treatment effect was found (OR 1.11; 95% CI 0.58–1.56). The ecological analysis indicated no statistically significant different likelihood (β = − 0.002%; P = 0.99) of good functional outcome at hospitals using IVT 1% more frequently. For GA, we found non-significant opposite directions of points estimates the treatment effect in the individual-level (ORs ~ 0.60) versus the instrumental variable approach (OR = 1.04). The ecological analysis also resulted in a non-significant negative association (0.03% lower probability).
Discussion and conclusion
Both magnitude and direction of the estimated treatment effects for both interventions depend strongly on the statistical approach and thus on the source of (unmeasured) confounding. These issues should be understood concerning the specific characteristics of data, before applying an approach and interpreting the results. Instrumental variable analysis might be considered when unobserved confounding and practice variation is expected in observational multicenter studies.
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Wagner B, Lorscheider J, Wiencierz A, Blackham K, Psychogios M, Bolliger D, De Marchis GM, Engelter ST, Lyrer P, Wright PR, Fischer U, Mordasini P, Nannoni S, Puccinelli F, Kahles T, Bianco G, Carrera E, Luft AR, Cereda CW, Kägi G, Weber J, Nedeltchev K, Michel P, Gralla J, Arnold M, Bonati LH. Endovascular Treatment for Acute Ischemic Stroke With or Without General Anesthesia: A Matched Comparison. Stroke 2022; 53:1520-1529. [PMID: 35341319 PMCID: PMC10082068 DOI: 10.1161/strokeaha.121.034934] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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<0.001), the coarsened exact matching (n=332-524, using multiple imputations of missing values; OR, 1.60 [1.08-2.36]; 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.
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Affiliation(s)
- Benjamin Wagner
- Department of Neurology (B.W., J.L., G.M.D.M., S.T.E., P.L., L.H.B.), University Hospital Basel and University of Basel, Switzerland
| | - Johannes Lorscheider
- Department of Neurology (B.W., J.L., G.M.D.M., S.T.E., P.L., L.H.B.), University Hospital Basel and University of Basel, Switzerland
| | - Andrea Wiencierz
- Clinical Trial Unit (A.W., P.R.W.), University Hospital Basel and University of Basel, Switzerland
| | - Kristine Blackham
- Institute of Diagnostic and Interventional Neuroradiology (K.B., M.P.), University Hospital Basel and University of Basel, Switzerland
| | - Marios Psychogios
- Institute of Diagnostic and Interventional Neuroradiology (K.B., M.P.), University Hospital Basel and University of Basel, Switzerland
| | - Daniel Bolliger
- Department of Anesthesiology (D.B.), University Hospital Basel and University of Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology (B.W., J.L., G.M.D.M., S.T.E., P.L., L.H.B.), University Hospital Basel and University of Basel, Switzerland
| | - Stefan T Engelter
- Department of Neurology (B.W., J.L., G.M.D.M., S.T.E., P.L., L.H.B.), University Hospital Basel and University of Basel, Switzerland.,Neurology and Neurorehabilitation, University Department of Geriatic Medicine FELIX PLATTER and Department of Clinical Research, University of Basel, Switzerland (S.T.E.)
| | - Philippe Lyrer
- Department of Neurology (B.W., J.L., G.M.D.M., S.T.E., P.L., L.H.B.), University Hospital Basel and University of Basel, Switzerland
| | - Patrick R Wright
- Clinical Trial Unit (A.W., P.R.W.), University Hospital Basel and University of Basel, Switzerland
| | - Urs Fischer
- Department of Neurology (U.F., M.A.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Stefania Nannoni
- Department of Neurology, Lausanne University Hospital, Switzerland (S.N., F.P., P.M.)
| | - Francesco Puccinelli
- Department of Neurology, Lausanne University Hospital, Switzerland (S.N., F.P., P.M.)
| | - Timo Kahles
- Department of Neurology, Cantonal Hospital Aarau, Switzerland (T.K., K.N.)
| | - Giovanni Bianco
- Stroke Center EOC, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano (G.B., C.W.C.)
| | - Emmanuel Carrera
- Department of Neurology, University Hospital Geneva, Switzerland (E.C.)
| | - Andreas R Luft
- Department of Neurology, University Hospital Zurich, Switzerland (A.R.L.).,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.R.L.)
| | - Carlo W Cereda
- Stroke Center EOC, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano (G.B., C.W.C.)
| | - Georg Kägi
- Department of Neurology (G.K.), Cantonal Hospital St. Gallen, Switzerland
| | - Johannes Weber
- Institute of Diagnostic and Interventional Neuroradiology (J.W.), Cantonal Hospital St. Gallen, Switzerland
| | - Krassen Nedeltchev
- Department of Neurology, Cantonal Hospital Aarau, Switzerland (T.K., K.N.)
| | - Patrik Michel
- Institute of Diagnostic and Interventional Neuroradiology (P.M., J.G.), Inselspital, Bern University Hospital, University of Bern, Switzerland.,Department of Neurology, Lausanne University Hospital, Switzerland (S.N., F.P., P.M.)
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology (P.M., J.G.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology (U.F., M.A.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Leo H Bonati
- Department of Neurology (B.W., J.L., G.M.D.M., S.T.E., P.L., L.H.B.), University Hospital Basel and University of Basel, Switzerland.,Research Department, Reha Rheinfelden, Switzerland (L.H.B.)
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Fischer C, Vulcu S, Goldberg J, Wagner F, Rodriguez B, Söll N, Mordasini P, Haenggi M, Schefold JC, Raabe A, Z'Graggen WJ. Anesthesia modality does not affect clinical outcomes of intra-arterial vasodilator treatment in patients with symptomatic cerebral vasospasms. F1000Res 2021; 10:417. [PMID: 34394915 PMCID: PMC8356260 DOI: 10.12688/f1000research.52324.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Delayed cerebral ischemia and cerebral vasospasm remain the leading causes of poor outcome in survivors of aneurysmal subarachnoid hemorrhage. Refractory cerebral vasospasms can be treated with endovascular vasodilator therapy, which can either be performed in conscious sedation or general anesthesia. The aim of this study is to compare the effect of the anesthesia modality on long-term clinical outcomes in patients undergoing endovascular vasodilator therapy due to cerebral vasospasm and hypoperfusion. Methods: Modified Rankin Scale (mRS) scores were retrospectively analyzed at time of discharge from the hospital and six months after aneurysmal subarachnoid hemorrhage. Additionally, National Institutes of Health Stroke Scale (NIHSS) was assessed 24 hours before, immediately before, immediately after, and 24 hours after endovascular vasodilator therapy, and at discharge and six months. Interventional parameters such as duration of intervention, choice and dosage of vasodilator and number of arteries treated were also recorded. Results: A total of 98 patients were included in this analysis and separated into patients who had interventions in conscious sedation, general anesthesia and a mix of both. Neither mRS at discharge nor at six months showed a significant difference for functionally independent outcomes (mRS 0-2) between groups. NIHSS before endovascular vasodilator therapy was significantly higher in patients receiving interventions in general anesthesia but did not differ anymore between groups six months after the initial bleed. Conclusion: This study did not observe a difference in outcome whether patients underwent endovascular vasodilator therapy in general anesthesia or conscious sedation for refractory cerebral vasospasms. Hence, the choice should be made for each patient individually.
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Affiliation(s)
- Corinne Fischer
- Department of Neurosurgery, Inselspital, University Hospital Bern, Bern, 3010, Switzerland
| | - Sonja Vulcu
- Department of Neurosurgery, Inselspital, University Hospital Bern, Bern, 3010, Switzerland
| | - Johannes Goldberg
- Department of Neurosurgery, Inselspital, University Hospital Bern, Bern, 3010, Switzerland
| | - Franca Wagner
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, 3010, Switzerland
| | - Belén Rodriguez
- Department of Neurosurgery, Inselspital, University Hospital Bern, Bern, 3010, Switzerland
| | - Nicole Söll
- Department of Neurosurgery, Inselspital, University Hospital Bern, Bern, 3010, Switzerland
| | - Pasquale Mordasini
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, 3010, Switzerland
| | - Matthias Haenggi
- Department of Intensive Care Medicine, Inselspital, University Hospital Bern, Bern, 3010, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, University Hospital Bern, Bern, 3010, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, University Hospital Bern, Bern, 3010, Switzerland
| | - Werner J Z'Graggen
- Department of Neurosurgery, Inselspital, University Hospital Bern, Bern, 3010, Switzerland
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Jing Z, Li H, Huang S, Guan M, Li Y, Lu K, Wu J, Zhong W, Huang L. Outcome of endovascular treatment within and beyond 6 h without perfusion software. Sci Rep 2021; 11:5342. [PMID: 33674715 PMCID: PMC7935958 DOI: 10.1038/s41598-021-84857-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/22/2021] [Indexed: 11/09/2022] Open
Abstract
Endovascular treatment (EVT) has been accepted as the standard of care for patients with acute ischemic stroke. The aim of the present study was to compare clinical outcomes of patients who received EVT within and beyond 6 h from symptom onset to groin puncture without perfusion software in Guangdong district, China. Between March 2017 and May 2018, acute ischemic stroke patients who received EVT from 6 comprehensive stroke centers, were enrolled into the registry study. In this subgroup study, we included all patients who had acute proximal large vessel occlusion in the anterior circulation. The demographic, clinical and neuroimaging data were collected from each center. A total of 192 patients were included in this subgroup study. They were divided into two groups: group A (n = 125), within 6 h; group B (n = 67), 6-24 h from symptom onset to groin puncture. There were no substantial differences between these two groups in terms of 90 days favorable outcome (modified Rankin scale [mRS] ≤ 2, P = 0.051) and mortality (P = 0.083), and the risk of symptomatic intracranial hemorrhage at 24 h (P = 0.425). The NIHSS (median 16, IQR12-20, group A; median 12, IQR8-18, group B; P = 0.009) and ASPECTS (median 10, IQR8-10, group A; median 9, IQR8-10, group B; P = 0.034) at baseline were higher in group A. The anesthesia method (general anesthesia, 21.3%, group A vs. 1.5% group B, P = 0.001) were also statistically different between the two groups. The NIHSS and ASPECTS were higher, and general anesthesia was also more widely used in group A. Clinical outcomes were not significantly different within 6 h versus 6-24 h from symptom onset to groin puncture in this real world study.
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Affiliation(s)
- Zhen Jing
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hao Li
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Shengming Huang
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Min Guan
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yongxin Li
- Department of Neurology, Shunde Hospital of Southern Medical University, Foshan, China
| | - Kui Lu
- Department of Neurology, Zhongshan People's Hospital, Zhongshan, China
| | - Jianzhou Wu
- Department of Neurology, Yunfu People's Hospital, Yunfu, China
| | - Wangtao Zhong
- Department of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Li'an Huang
- Department of Neurology, Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China.
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Majidi S, Lee J, Balushi AA, Fifi JT, Singh IP. Endovascular thrombectomy in octogenarians and nonagenarians with large vessel occlusion: Technical aspects and clinical outcome. J Stroke Cerebrovasc Dis 2020; 29:105120. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/10/2020] [Accepted: 06/29/2020] [Indexed: 12/27/2022] Open
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Morrison C, Aravindan S, Rennie A, Liversedge T. Stroke management in children. Paediatr Anaesth 2020; 30:17-24. [PMID: 31733159 DOI: 10.1111/pan.13768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Christa Morrison
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
| | | | - Adam Rennie
- Department of Interventional Radiology, Great Ormond Street Hospital, London, UK
| | - Tim Liversedge
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
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