Conscious sedation versus general anesthesia during endovascular therapy for acute anterior circulation stroke: preliminary results from a retrospective, multicenter study.
OBJECTIVE
Patients undergoing intra-arterial therapy (IAT) for acute ischemic stroke receive either general anesthesia (GA) or conscious sedation. GA may delay time to treatment, whereas conscious sedation may result in patient movement and compromise the safety of the procedure. We sought to determine whether there were differences in safety and outcomes in GA patients before initiation of IAT.


METHODS
A cohort of 980 patients at 12 stroke centers underwent IAT for acute stroke between 2005 and 2009. Only patients with anterior circulation strokes due to large-vessel occlusion were included in the study. A binary logistic-regression model was used to determine independent predictors of good outcome and death.


RESULTS
The mean age was 66+/-15 years and median National Institutes of Health Stroke Scale score was 17 (interquartile range, 13-20). The overall recanalization rate was 68% and the symptomatic hemorrhage rate was 9.2%. GA was used in 44% of patients with no differences in intracranial hemorrhage rates when compared with the conscious sedation group. The use of GA was associated with poorer neurologic outcome at 90 days (odds ratio=2.33; 95% CI, 1.63-3.44; P<0.0001) and higher mortality (odds ratio=1.68; 95% CI, 1.23-2.30; P<0.0001) compared with conscious sedation.


CONCLUSIONS
Patients placed under GA during IAT for anterior circulation stroke appear to have a higher chance of poor neurologic outcome and mortality. There do not appear to be differences in hemorrhagic complications between the 2 groups. Future clinical trials with IAT can help elucidate the etiology of the differences in outcomes.
Abou-Chebl
Alex
A
Department of Neurology, Vanderbilt Stroke Center, A-0118 Medical Center North, Nashville, TN 37232-2551, USA.
Lin
Ridwan
R
Hussain
Muhammad Shazam
MS
Jovin
Tudor G
TG
Levy
Elad I
EI
Liebeskind
David S
DS
Yoo
Albert J
AJ
Hsu
Daniel P
DP
Rymer
Marilyn M
MM
Tayal
Ashis H
AH
Zaidat
Osama O
OO
Natarajan
Sabareesh K
SK
Nogueira
Raul G
RG
Nanda
Ashish
A
Tian
Melissa
M
Hao
Qing
Q
Kalia
Junaid S
JS
Nguyen
Thanh N
TN
Chen
Michael
M
Gupta
Rishi
R
D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D002545:Brain Ischemia / Q000473:pathology* / Q000628:therapy*; D015331:Cohort Studies; D016292:Procedural Sedation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate