TY - JOUR
T1 - Association between anesthesia modality and clinical outcomes following endovascular stroke treatment in the extended time window
AU - Dhillon, Permesh Singh
AU - Butt, Waleed
AU - Podlasek, Anna
AU - McConachie, Norman
AU - Lenthall, Robert
AU - Nair, Sujit
AU - Malik, Luqman
AU - Hewson, David W
AU - Bhogal, Pervinder
AU - Makalanda, Hegoda Levansri Dilrukshan
AU - James, Martin A.
AU - Dineen, Robert A.
AU - England, Timothy J.
N1 - Funding Information:
SSNAP is commissioned by the Health Quality Improvement Partnership and funded by National Health Service (NHS) England and the Welsh Government. MAJ is supported by the National Institute for Health Research Applied Research Collaboration South West Peninsula.
Copyright:
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/4/13
Y1 - 2023/4/13
N2 - 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.
AB - 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.
KW - Humans
KW - Brain Ischemia/surgery
KW - Prospective Studies
KW - Treatment Outcome
KW - Stroke/diagnosis
KW - Anesthesia, General/adverse effects
KW - Endovascular Procedures/adverse effects
KW - Thrombectomy/methods
KW - Blood Pressure
KW - Intervention
KW - Stroke
KW - Thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85130824978&partnerID=8YFLogxK
U2 - 10.1136/neurintsurg-2022-018846
DO - 10.1136/neurintsurg-2022-018846
M3 - Article
C2 - 35450928
SN - 1759-8478
VL - 15
SP - 478
EP - 482
JO - Journal of Neurointerventional Surgery
JF - Journal of Neurointerventional Surgery
IS - 5
ER -