title: Comparison of safety and clinical and radiographic outcomes in endovascular acute stroke therapy for proximal middle cerebral artery occlusion with intubation and general anesthesia versus the nonintubated state.
abstract: OBJECTIVE
  There is considerable heterogeneity in practice patterns between sedation in the intubated state vs nonintubated state during endovascular acute stroke therapy. We sought to compare clinical and radiographic outcomes between these 2 sedation modalities.
  
  
  METHODS
  Consecutive patients with acute stroke due to middle cerebral artery-M1 segment occlusion treated with endovascular therapy between January 2006 and July 2009 were identified in our interventional acute stroke database. Level of sedation was determined as intubated (IS) vs nonintubated (NIS) state. Final infarct volumes on follow-up imaging and clinical outcomes at 3 to 6 months were obtained.
  
  
  RESULTS
  A total of 126 patients were included (73 [58%] NIS vs 53 [42%] IS). In IS patients, intensive care unit length of stay was longer (6.5 vs 3.2 days, P=0.0008). Intraprocedural complications were lower in NIS patients compared with IS patients (5/73 [6%] vs 8/53 [15%], respectively), but the difference was not significant (P=0.13). In univariate and multivariate analyses, NIS was significantly associated with in-hospital mortality (odds ratio=0.32, P=0.011), good clinical outcome (odds ratio=3.06, P=0.042), and final infarct volume (odds ratio=0.25, P=0.004).
  
  
  CONCLUSIONS
  In endovascular acute stroke therapy, treatment of patients in NIS appears to be as safe as treatment in IS and may result in more favorable clinical and radiographic outcomes. Our preliminary observations derived from this retrospective study await confirmation from prospective trials.
authors.affiliation: Center for Neuroendovascular Therapy, UPMC Stroke Institute, Suite C424, 200 Lothrop St, Pittsburgh, PA 15213, USA.
authors.forename: Mouhammad A
authors.initials: MA
authors.lastname: Jumaa
authors.forename: Fan
authors.initials: F
authors.lastname: Zhang
authors.forename: Gerardo
authors.initials: G
authors.lastname: Ruiz-Ares
authors.forename: Theresa
authors.initials: T
authors.lastname: Gelzinis
authors.forename: Amer M
authors.initials: AM
authors.lastname: Malik
authors.forename: Aitziber
authors.initials: A
authors.lastname: Aleu
authors.forename: Jennifer I
authors.initials: JI
authors.lastname: Oakley
authors.forename: Brian
authors.initials: B
authors.lastname: Jankowitz
authors.forename: Ridwan
authors.initials: R
authors.lastname: Lin
authors.forename: Vivek
authors.initials: V
authors.lastname: Reddy
authors.forename: Syed F
authors.initials: SF
authors.lastname: Zaidi
authors.forename: Maxim D
authors.initials: MD
authors.lastname: Hammer
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Wechsler
authors.forename: Michael
authors.initials: M
authors.lastname: Horowitz
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D002533:Cerebral Angiography; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D007440:Intubation / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*