General anesthesia versus monitored anesthesia care during endovascular therapy for vertebrobasilar stroke

Guangjun Hu, Zhen Shi, Bixi Li, Weidong Shao, Bo Xu, Guangjun Hu, Zhen Shi, Bixi Li, Weidong Shao, Bo Xu

Abstract

Objective: The objective is to compare the effect of general anesthesia (GA) and monitored anesthesia care (MAC) on clinical outcomes in patients with endovascular therapy for vertebrobasilar occlusion stroke.

Methods: 139 patients undergoing endovascular therapy for vertebrobasilar stroke, were recruited. The patients were randomized into GA group and MAC group (about 1:1 ratio). GA group received general anesthesia and MAC group received monitored anesthesia care during endovascular therapy. The primary outcome measure was the shift in the degree of disability among the 2 groups as measured by the modified Rankin scale score (mRS) at 90 days (80-100 days). Secondary end points included infarct volume and related complications.

Results: The patients were assigned randomly (about 1:1 allocation) to GA group (n=72) and MAC group (n=67). The primary outcome of functional independence measured by 90-day mRS score was not significantly different between the 2 groups (median (IQR), 2 (1-3) vs. 3 (1-4); P=0.316). Final infarct volume was smaller in the GA group than in the MAC group (median (IQR), 27.60 (13.75-83.52) vs. 33.60 (26.85-92.95); P=0.045). There were no differences with statistical significance in rates of successful reperfusion (modified Thrombolysis in Cerebral Ischemia (mTICI) 2b-3) between 2 groups (73.61% vs. 76.12%; P=0.734). Early neurological outcomes measured by the 24-hour National Institutes of Health Stroke Scale scores (NIHSS) showed that 11 (interquartile range (IQR), 3-22) in GA group and 11 (interquartile range (IQR), 7-25) in MAC group, but were not statistically significant. There was no statistical difference in postoperative complications between the two groups.

Conclusion: For patients who underwent endovascular therapy for vertebrobasilar occlusion strok caused by occlusions in the posterior circulation, MAC appears to be as effective as GA. However, MAC is associated with bigger final infarct volume. Future studies are warranted to confirm our findings.

Keywords: General anesthesia; endovascular therapy; monitored anesthesia care; vertebrobasilar stroke.

Conflict of interest statement

None.

AJTR Copyright © 2021.

Figures

Figure 1
Figure 1
Flowchart of the study sample. GA: general anesthesia; MAC: monitored anesthesia care.
Figure 2
Figure 2
Bar graphs comparing the rates. A: Successful reperfusion after ET; B: Intraoperative mean arterial pressure for the GA (black) vs. MAC (gray) groups. GA: general anesthesia; MAC: monitored anesthesia care; mTICI: modified Thrombolysis in Cerebral Ischemia. * indicates that there was a statistical difference between two groups with P=0.046.
Figure 3
Figure 3
Shift analysis as assessed by the Mann-Whitney U-test, P=0.316. MAC: monitored anesthesia care; GA: general anesthesia.
Figure 4
Figure 4
Primary outcome as the Improvement of mRS Score in Prespecified Subgroups. No significant difference for the primary outcome was observed between the treatment groups in the subgroup analyses, except the subgroup with gender (female). GA: general anesthesia; MAC: monitored anesthesia care; NIHSS: National Institutes of Health Stroke Scale scores.

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