title: Type of anesthesia and differences in clinical outcome after intra-arterial treatment for ischemic stroke.
abstract: OBJECTIVE
  Intra-arterial treatment (IAT) in patients with acute ischemic stroke (AIS) can be performed with or without general anesthesia (GA). Previous studies suggested that IAT without the use of GA (non-GA) is associated with better clinical outcome. Nevertheless, no consensus exists about the anesthetic management during IAT of AIS patients. This study investigates the association between type of anesthesia and clinical outcome in a large cohort of patients with AIS treated with IAT.
  
  
  METHODS
  All consecutive patients with AIS of the anterior circulation who received IAT between 2002 and 2013 in 16 Dutch hospitals were included in the study. Primary outcome was functional outcome on the modified Rankin Scale at discharge. Difference in primary outcome between GA and non-GA was estimated using multiple ordinal regression analysis, adjusting for age, stroke severity, occlusion of the internal carotid artery terminus, previous stroke, atrial fibrillation, and diabetes mellitus.
  
  
  RESULTS
  Three hundred forty-eight patients were included in the analysis; 70 patients received GA and 278 patients did not receive GA. Non-GA was significantly associated with good clinical outcome (odds ratio 2.1, 95% confidence interval 1.02-4.31). After adjusting for prespecified prognostic factors, the point estimate remained similar; statistical significance, however, was lost (odds ratio 1.9, 95% confidence interval 0.89-4.24).
  
  
  CONCLUSIONS
  Our study suggests that patients with AIS of the anterior circulation undergoing IAT without GA have a higher probability of good clinical outcome compared with patients treated with general anesthesia.
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Lucie A
authors: LA
authors: van den Berg
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Diederik L H
authors: DL
authors: Koelman
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Olvert A
authors: OA
authors: Berkhemer
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Anouk D
authors: AD
authors: Rozeman
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Puck S S
authors: PS
authors: Fransen
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Debbie
authors: D
authors: Beumer
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Diederik W
authors: DW
authors: Dippel
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Aad
authors: A
authors: van der Lugt
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Robert J
authors: RJ
authors: van Oostenbrugge
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Wim H
authors: WH
authors: van Zwam
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Patrick A
authors: PA
authors: Brouwer
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Sjoerd
authors: S
authors: Jenniskens
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Jelis
authors: J
authors: Boiten
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Geert A
authors: GA
authors: Lycklama À Nijeholt
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Jan Albert
authors: JA
authors: Vos
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Wouter J
authors: WJ
authors: Schonewille
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands.
authors: Charles B L M
authors: CB
authors: Majoie
authors: From the Departments of Neurology (L.A.v.d.B., D.L.H.K., Y.B.W.E.M.R.) and Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (A.D.R., J.B.) and Radiology (G.A.L.à.N.), Medical Center Haaglanden, The Hague, The Netherlands; Departments of Neurology (P.S.S.F., D.W.D.) and Radiology (P.S.S.F., A.v.d.L., P.A.B.), Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.) and Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (S.J.); and Department of Neurology (J.A.V.) and Radiology (W.J.S.), Sint Antonius Hospital, Nieuwegein, The Netherlands. y.b.roos@amc.uva.nl.
authors: Yvo B W E M
authors: YB
authors: Roos
mesh_terms: D000367:Age Factors; D000368:Aged; D000768:Anesthesia, General; D002545:Brain Ischemia / Q000473:pathology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D015424:Reperfusion; D012189:Retrospective Studies; D020521:Stroke / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: acute stroke; anesthesia; conscious sedation; thrombectomy; thrombolytic therapy