General Anesthesia Versus Conscious Sedation and Local Anesthesia During Thrombectomy for Acute Ischemic Stroke
Manuel Cappellari, Giovanni Pracucci, Stefano Forlivesi, Valentina Saia, Sergio Nappini, Patrizia Nencini, Domenico Inzitari, Laura Greco, Fabrizio Sallustio, Stefano Vallone, Guido Bigliardi, Andrea Zini, Antonio Pitrone, Francesco Grillo, Rosa Musolino, Sandra Bracco, Rebecca Tinturini, Rossana Tassi, Mauro Bergui, Paolo Cerrato, Andrea Saletti, Alessandro De Vito, Ilaria Casetta, Roberto Gasparotti, Mauro Magoni, Lucio Castellan, Laura Malfatto, Roberto Menozzi, Umberto Scoditti, Francesco Causin, Claudio Baracchini, Edoardo Puglielli, Alfonsina Casalena, Maria Ruggiero, Emanuele Malatesta, Chiara Comelli, Gigliola Chianale, Dario Luca Lauretti, Michelangelo Mancuso, Elvis Lafe, Anna Cavallini, Nicola Cavasin, Adriana Critelli, Elisa Francesca Maria Ciceri, Bruno Bonetti, Luigi Chiumarulo, Marco Petruzzelli, Andrea Giorgianni, Maurizio Versino, Maria Porzia Ganimede, Angelica Tinelli, Wiliam Auteri, Alfredo Petrone, Giulio Guidetti, Ettore Nicolini, Luca Allegretti, Tiziana Tassinari, Pietro Filauri, Simona Sacco, Marco Pavia, Paolo Invernizzi, Nunzio Paolo Nuzzi, Maria Carmela Spinelli, Pietro Amistà, Monia Russo, Delfina Ferrandi, Simona Corraine, Giuseppe Craparo, Marina Mannino, Luigi Simonetti, Danilo Toni, Salvatore Mangiafico, Manuel Cappellari, Giovanni Pracucci, Stefano Forlivesi, Valentina Saia, Sergio Nappini, Patrizia Nencini, Domenico Inzitari, Laura Greco, Fabrizio Sallustio, Stefano Vallone, Guido Bigliardi, Andrea Zini, Antonio Pitrone, Francesco Grillo, Rosa Musolino, Sandra Bracco, Rebecca Tinturini, Rossana Tassi, Mauro Bergui, Paolo Cerrato, Andrea Saletti, Alessandro De Vito, Ilaria Casetta, Roberto Gasparotti, Mauro Magoni, Lucio Castellan, Laura Malfatto, Roberto Menozzi, Umberto Scoditti, Francesco Causin, Claudio Baracchini, Edoardo Puglielli, Alfonsina Casalena, Maria Ruggiero, Emanuele Malatesta, Chiara Comelli, Gigliola Chianale, Dario Luca Lauretti, Michelangelo Mancuso, Elvis Lafe, Anna Cavallini, Nicola Cavasin, Adriana Critelli, Elisa Francesca Maria Ciceri, Bruno Bonetti, Luigi Chiumarulo, Marco Petruzzelli, Andrea Giorgianni, Maurizio Versino, Maria Porzia Ganimede, Angelica Tinelli, Wiliam Auteri, Alfredo Petrone, Giulio Guidetti, Ettore Nicolini, Luca Allegretti, Tiziana Tassinari, Pietro Filauri, Simona Sacco, Marco Pavia, Paolo Invernizzi, Nunzio Paolo Nuzzi, Maria Carmela Spinelli, Pietro Amistà, Monia Russo, Delfina Ferrandi, Simona Corraine, Giuseppe Craparo, Marina Mannino, Luigi Simonetti, Danilo Toni, Salvatore Mangiafico
Abstract
Background and purpose: As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA).
Methods: We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke.
Results: GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0-1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602-1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515-0.990). The rates of modified Rankin Scale score of 0-2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689-1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566-0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644-1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844-1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262-0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337-0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of <1, antiplatelet, and anticoagulant), differences were found also between GA versus CS as regards modified Rankin Scale score of 0-2 (aOR, 0.659 [95% CI, 0.538-0.807]) and GA versus LA as regards death (aOR, 1.413 [95% CI, 1.095-1.823]).
Conclusions: GA during thrombectomy was associated with worse 3-month functional outcomes, especially when compared with LA. The inclusion of an LA arm in future randomized clinical trials of anesthesia strategy is recommended.
Keywords: anesthesia; conscious sedation; groin; odds ratio; thrombectomy.
Source: PubMed