Association between anesthesia modality and clinical outcomes following endovascular stroke treatment in the extended time window

Permesh Singh Dhillon (Lead / Corresponding author), Waleed Butt, Anna Podlasek, Norman McConachie, Robert Lenthall, Sujit Nair, Luqman Malik, David W Hewson, Pervinder Bhogal, Hegoda Levansri Dilrukshan Makalanda, Martin A. James, Robert A. Dineen, Timothy J. England

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
26 Downloads (Pure)

Abstract

Background: There is a paucity of data on anesthesia-related outcomes for endovascular treatment (EVT) in the extended window (>6 hours from ischemic stroke onset). We compared functional and safety outcomes between local anesthesia (LA) without sedation, conscious sedation (CS) and general anesthesia (GA).

Methods: Patients who underwent EVT in the early (<6 hours) and extended time windows using LA, CS, or GA between October 2015 and March 2020 were included from a UK national stroke registry. Multivariable analyses were performed, adjusted for age, sex, baseline stroke severity, pre-stroke disability, EVT technique, center, procedural time and IV thrombolysis.

Results: A total of 4337 patients were included, 3193 in the early window (1135 LA, 446 CS, 1612 GA) and 1144 in the extended window (357 LA, 134 CS, 653 GA). Compared with GA, patients treated under LA alone had increased odds of an improved modified Rankin Scale (mRS) score at discharge (early: adjusted common (ac) OR=1.50, 95% CI 1.29 to 1.74, p=0.001; extended: acOR=1.29, 95% CI 1.01 to 1.66, p=0.043). Similar mRS scores at discharge were found in the LA and CS cohorts in the early and extended windows (p=0.21). Compared with CS, use of GA was associated with a worse mRS score at discharge in the early window (acOR=0.73, 95% CI 0.45 to 0.96, p=0.017) but not in the extended window (p=0.55). There were no significant differences in the rates of symptomatic intracranial hemorrhage or in-hospital mortality across the anesthesia modalities in the extended window.

Conclusion: LA without sedation during EVT was associated with improved functional outcomes compared with GA, but not CS, within and beyond 6 hours from stroke onset. Prospective studies assessing anesthesia-related outcomes in the extended time window are warranted.

Original languageEnglish
Pages (from-to)478-482
Number of pages5
JournalJournal of Neurointerventional Surgery
Volume15
Issue number5
Early online date21 Apr 2022
DOIs
Publication statusPublished - 13 Apr 2023

Keywords

  • Humans
  • Brain Ischemia/surgery
  • Prospective Studies
  • Treatment Outcome
  • Stroke/diagnosis
  • Anesthesia, General/adverse effects
  • Endovascular Procedures/adverse effects
  • Thrombectomy/methods
  • Blood Pressure
  • Intervention
  • Stroke
  • Thrombectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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