Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery

医学 冲程(发动机) 麻醉剂 麻醉 脑动脉 大脑前动脉 大脑后动脉 心脏病学 大脑中动脉 缺血 机械工程 工程类
作者
Lukas Meyer,Christian Paul Stracke,Gabriel Broocks,Marta Wallocha,Mohamed Elsharkawy,Peter B. Sporns,Eike I. Piechowiak,Johannes Kaesmacher,Christian Maegerlein,Moritz Roman Hernandez Petzsche,Hanna Zimmermann,Weis Naziri,Nuran Abdullayev,Christoph Kabbasch,Daniel Behme,Maximilian Thormann,Volker Maus,Sebastian Fischer,Markus Möhlenbruch,Charlotte S. Weyland,Sönke Langner,Marielle Ernst,Ala Jamous,Dan Meila,Milena Miszczuk,Eberhard Siebert,Stephan Lowens,Lars Udo Krause,Leonard L.L. Yeo,Benjamin Yong‐Qiang Tan,Anil Gopinathan,Benjamin Gory,Jorge Galván Fernández,Miguel Schüller Arteaga,Pedro Navía,Eytan Raz,Maksim Shapiro,Fabian Arnberg,Kamil Zeleňák,Mario Martínez‐Galdámez,Maria Eleni Alexandrou,Andreas Kastrup,Panagiotis Papanagiotou,Franziska Dorn,André Kemmling,Marios‐Nikos Psychogios,Tommy Andersson,René Chapot,Jens Fiehler,Uta Hanning
出处
期刊:Journal of NeuroInterventional Surgery [BMJ]
卷期号:16 (3): 230-236 被引量:5
标识
DOI:10.1136/jnis-2023-020210
摘要

Background Numerous questions regarding procedural details of distal stroke thrombectomy remain unanswered. This study assesses the effect of anesthetic strategies on procedural, clinical and safety outcomes following thrombectomy for distal medium vessel occlusions (DMVOs). Methods Patients with isolated DMVO stroke from the TOPMOST registry were analyzed with regard to anesthetic strategies (ie, conscious sedation (CS), local (LA) or general anesthesia (GA)). Occlusions were in the P2/P3 or A2–A4 segments of the posterior and anterior cerebral arteries (PCA and ACA), respectively. The primary endpoint was the rate of complete reperfusion (modified Thrombolysis in Cerebral Infarction score 3) and the secondary endpoint was the rate of modified Rankin Scale score 0–1. Safety endpoints were the occurrence of symptomatic intracranial hemorrhage and mortality. Results Overall, 233 patients were included. The median age was 75 years (range 64–82), 50.6% (n=118) were female, and the baseline National Institutes of Health Stroke Scale score was 8 (IQR 4–12). DMVOs were in the PCA in 59.7% (n=139) and in the ACA in 40.3% (n=94). Thrombectomy was performed under LA±CS (51.1%, n=119) and GA (48.9%, n=114). Complete reperfusion was reached in 73.9% (n=88) and 71.9% (n=82) in the LA±CS and GA groups, respectively (P=0.729). In subgroup analysis, thrombectomy for ACA DMVO favored GA over LA±CS (aOR 3.07, 95% CI 1.24 to 7.57, P=0.015). Rates of secondary and safety outcomes were similar in the LA±CS and GA groups. Conclusion LA±CS compared with GA resulted in similar reperfusion rates after thrombectomy for DMVO stroke of the ACA and PCA. GA may facilitate achieving complete reperfusion in DMVO stroke of the ACA. Safety and functional long-term outcomes were comparable in both groups.
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