title: Hypotension During Endovascular Treatment of Ischemic Stroke Is a Risk Factor for Poor Neurological Outcome.
abstract: OBJECTIVE
  In retrospective studies, patients receiving general anesthesia for endovascular treatment for acute ischemic stroke have worse neurological outcome compared with patients receiving conscious sedation. It has been suggested that this is caused by general anesthesia-associated hypotension. We investigated the effect of intraprocedural hypotension on neurological outcome.
  
  
  METHODS
  One hundred eight patients with acute ischemic stroke, who underwent endovascular treatment in general anesthesia between 2007 and 2012, were included. Analyzed predictors of neurological outcome were age, sex, comorbidities, baseline National Institutes of Health Stroke Scale, intraprocedural relative changes in mean arterial blood pressure from baseline, blood glucose, modified Thrombolysis in Cerebral Infarction score, and elapsed time from stroke to computed tomography, groin puncture, and recanalization/end of procedure.
  
  
  RESULTS
  A fall in mean arterial blood pressure of >40% was an independent predictor for poor neurological outcome (P=0.032), as were higher admission National Institutes of Health Stroke Scale score (P=0.008) and lack of recanalization (P=0.003).
  
  
  CONCLUSIONS
  Profound intraprocedural hypotension is an independent predictor for poor neurological outcome in patients with acute ischemic stroke undergoing endovascular therapy in general anesthesia.
authors.affiliation: From the Departments of Anaesthesiology and Intensive Care Medicine (P.L.H., H.S., B.R., S.-E.R.), Neuroradiology (A.R.), and Neurorology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. pia.lowhagen@vgregion.se.
authors.forename: Pia
authors.initials: P
authors.lastname: Löwhagen Hendén
authors.affiliation: From the Departments of Anaesthesiology and Intensive Care Medicine (P.L.H., H.S., B.R., S.-E.R.), Neuroradiology (A.R.), and Neurorology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Rentzos
authors.affiliation: From the Departments of Anaesthesiology and Intensive Care Medicine (P.L.H., H.S., B.R., S.-E.R.), Neuroradiology (A.R.), and Neurorology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Jan-Erik
authors.initials: JE
authors.lastname: Karlsson
authors.affiliation: From the Departments of Anaesthesiology and Intensive Care Medicine (P.L.H., H.S., B.R., S.-E.R.), Neuroradiology (A.R.), and Neurorology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Rosengren
authors.affiliation: From the Departments of Anaesthesiology and Intensive Care Medicine (P.L.H., H.S., B.R., S.-E.R.), Neuroradiology (A.R.), and Neurorology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Sundeman
authors.affiliation: From the Departments of Anaesthesiology and Intensive Care Medicine (P.L.H., H.S., B.R., S.-E.R.), Neuroradiology (A.R.), and Neurorology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Reinsfelt
authors.affiliation: From the Departments of Anaesthesiology and Intensive Care Medicine (P.L.H., H.S., B.R., S.-E.R.), Neuroradiology (A.R.), and Neurorology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Sven-Erik
authors.initials: SE
authors.lastname: Ricksten
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects*; D002545:Brain Ischemia / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000601:surgery*; D016896:Treatment Outcome
keywords: anesthesia; blood pressure; conscious sedation; hypotension; stroke