TY - JOUR
T1 - Anesthesia modality in endovascular treatment for distal medium vessel occlusion stroke
T2 - Intention-to-treat propensity score-matched analysis
AU - Mohammaden, Mahmoud H.
AU - Doheim, Mohamed F.
AU - Abdelhamid, Hend
AU - Matsoukas, Stavros
AU - Schuldt, Braxton Riley
AU - Fifi, Johanna T.
AU - Kuybu, Okkes
AU - Gross, Bradley A.
AU - Al-Bayati, Alhamza R.
AU - Dolia, Jaydevsinh
AU - Grossberg, Jonathan A.
AU - Olive-Gadea, Marta
AU - Rodrigo-Gisbert, Marc
AU - Requena, Manuel
AU - Monteiro, Andre
AU - Yu, Siyuan
AU - Siegler, James E.
AU - Rodriguez-Calienes, Aaron
AU - Galecio-Castillo, Milagros
AU - Ortega-Gutierrez, Santiago
AU - Cortez, Gustavo M.
AU - Hanel, Ricardo A.
AU - Aghaebrahim, Amin
AU - Hassan, Ameer E.
AU - Nguyen, Thanh N.
AU - Abdalkader, Mohamad
AU - Klein, Piers
AU - Salem, Mohamed M.
AU - Burkhardt, Jan Karl
AU - Jankowitz, Brian T.
AU - Colasurdo, Marco
AU - Kan, Peter
AU - Hafeez, Muhammad
AU - Tanweer, Omar
AU - Peng, Sophia
AU - Alaraj, Ali
AU - Siddiqui, Adnan H.
AU - Nogueira, Raul G.
AU - Haussen, Diogo C.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2024
Y1 - 2024
N2 - Background: The optimal anesthesia modality during endovascular treatment (EVT) for distal medium vessel occlusion (DMVO) stroke is uncertain. We aimed to evaluate the association of the anesthesia modality with procedural and clinical outcomes following EVT for DMVO stroke. Methods: This is a multicenter retrospective analysis of a prospectively collected database. Patients were included if they had DMVO involving the middle cerebral artery-M3/4, anterior cerebral artery-A2/3, or posterior cerebral artery-P1/P2-3, and underwent EVT. The cohort was divided into two groups, general anesthesia (GA) and non-general anesthesia (non-GA), and compared based on the intention-to-treat principle as primary analysis. We used propensity scores to balance the two groups. The primary outcome was the shift in the degree of disability as measured by the 90-day modified Rankin Scale (mRS). Secondary outcomes included successful reperfusion, as well as excellent (mRS 0-1) and good (mRS 0-2) clinical outcomes at 90 days. Safety measures included procedural complications, symptomatic intracerebral hemorrhage (sICH), and 90-day mortality. Results: Among 366 DMVO thrombectomies, 61 matched pairs were eligible for analysis. Median age and National Institutes of Health Stroke Scale score as well as other baseline demographic and clinical characteristics were balanced between both groups. The GA group had no difference in the overall degree of disability (common OR 1.19, 95% CI 0.52 to 2.86, P=0.67) compared with the non-GA arm. Likewise, the GA group had comparable rates of successful reperfusion (OR 2.38, 95% CI 0.80 to 7.07, P=0.12), good/excellent clinical outcomes (OR 1.14, 95% CI 0.44 to 2.96, P=0.79/(OR 0.65, 95% CI 0.24 to 1.81, P=0.41), procedural complications (OR 1.00, 95% CI 0.19 to 5.16, P>0.99), sICH (OR 3.24, 95% CI 0.83 to 12.68, P=0.09), and 90-day mortality (OR 1.43, 95% CI 0.48 to 4.27, P=0.52) compared with the non-GA group. Conclusions: In patients with DMVO, our study showed that GA and non-GA groups had similar procedural and clinical outcomes, as well as safety measures. Further larger controlled studies are warranted.
AB - Background: The optimal anesthesia modality during endovascular treatment (EVT) for distal medium vessel occlusion (DMVO) stroke is uncertain. We aimed to evaluate the association of the anesthesia modality with procedural and clinical outcomes following EVT for DMVO stroke. Methods: This is a multicenter retrospective analysis of a prospectively collected database. Patients were included if they had DMVO involving the middle cerebral artery-M3/4, anterior cerebral artery-A2/3, or posterior cerebral artery-P1/P2-3, and underwent EVT. The cohort was divided into two groups, general anesthesia (GA) and non-general anesthesia (non-GA), and compared based on the intention-to-treat principle as primary analysis. We used propensity scores to balance the two groups. The primary outcome was the shift in the degree of disability as measured by the 90-day modified Rankin Scale (mRS). Secondary outcomes included successful reperfusion, as well as excellent (mRS 0-1) and good (mRS 0-2) clinical outcomes at 90 days. Safety measures included procedural complications, symptomatic intracerebral hemorrhage (sICH), and 90-day mortality. Results: Among 366 DMVO thrombectomies, 61 matched pairs were eligible for analysis. Median age and National Institutes of Health Stroke Scale score as well as other baseline demographic and clinical characteristics were balanced between both groups. The GA group had no difference in the overall degree of disability (common OR 1.19, 95% CI 0.52 to 2.86, P=0.67) compared with the non-GA arm. Likewise, the GA group had comparable rates of successful reperfusion (OR 2.38, 95% CI 0.80 to 7.07, P=0.12), good/excellent clinical outcomes (OR 1.14, 95% CI 0.44 to 2.96, P=0.79/(OR 0.65, 95% CI 0.24 to 1.81, P=0.41), procedural complications (OR 1.00, 95% CI 0.19 to 5.16, P>0.99), sICH (OR 3.24, 95% CI 0.83 to 12.68, P=0.09), and 90-day mortality (OR 1.43, 95% CI 0.48 to 4.27, P=0.52) compared with the non-GA group. Conclusions: In patients with DMVO, our study showed that GA and non-GA groups had similar procedural and clinical outcomes, as well as safety measures. Further larger controlled studies are warranted.
KW - Hemorrhage
KW - Stroke
KW - Thrombectomy
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U2 - 10.1136/jnis-2024-021668
DO - 10.1136/jnis-2024-021668
M3 - Article
C2 - 38782566
AN - SCOPUS:85194254181
SN - 1759-8478
JO - Journal of neurointerventional surgery
JF - Journal of neurointerventional surgery
M1 - jnis-2024-021668
ER -