General Anesthesia During Endovascular Stroke Therapy Does Not Negatively Impact Outcome.

Related Articles

General Anesthesia During Endovascular Stroke Therapy Does Not Negatively Impact Outcome.

World Neurosurg. 2016 Dec 22;:

Authors: Wang A, Stellfox M, Moy F, Abramowicz AE, Lehrer R, Epstein R, Eiden N, Aquilina A, Pednekar N, Brady G, Wecksell M, Cooley J, Santarelli J, Stiefel MF

Abstract
OBJECTIVE: Recent randomized trials, have demonstrated that endovascular therapy improves outcomes in patients with an acute ischemic stroke from a large vessel occlusion (LVO). Sub-group analysis of the MR CLEAN study found that patients undergoing general anesthesia (GA) for the procedure did worse than those with non-general anesthesia (non-GA). Current guidelines now suggest that we consider non-GA over GA, without large, randomized trials specifically designed to address this issue. We sought to review our experience and outcomes in a program where we routinely use GA in patients undergoing mechanical thrombectomy with similar techniques.
METHODS: Patients with anterior circulation strokes who received intravenous tissue plasminogen activator (IV-tPA) and endovascular stroke therapy were included in the analysis. National Institutes of Health Stroke Scale (NIHSS) on admission and discharge, and modified Rankin scales (mRS) at discharge were recorded and compared to the outcome measurements of MR CLEAN.
RESULTS: 60 patients were identified; 39 males and 21 females with a mean age of 62 (range of 29 to 88). 47 patients were transferred from outside primary stroke centers, while 13 patients presented directly to our institution. Median NIHSS on admission was 15. The median time of symptom onset to endovascular therapy was 265 minutes, with an interquartile range of 81 minutes. Using the thrombolysis in cerebral infarction (TICI) scale, recanalization of TICI 2b - 3 was achieved in 76.4% of recorded patients (42/55 recorded). At discharge, mortality was 16.7% (10/60), median NIHSS was 5 and 38.3% (23/60) of patients had a mRS score of 0 - 2.
CONCLUSIONS: General anesthesia does not worsen outcome in patients undergoing mechanical thrombectomy when compared to historical subgroups. Despite a longer time from symptom onset to treatment, our outcomes for patients receiving GA compare favorably to the GA and non-GA groups in MR CLEAN.

PMID: 28017749 [PubMed - as supplied by publisher]

http://ift.tt/2imO2Pc