Answering the Call: The Case for Anesthesiologist-led Care for All Stroke Thrombectomies

Whalin, Matthew K.; Sharma, Deepak

doi:10.1097/ana.0000000000000930

Cited by 2 publications

References 10 publications

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Anesthesia on Clinical Outcomes in an Extended Time Window During Endovascular Stroke Therapy: Exploratory Analysis of the ANGEL-ACT Registry

Wang,

Liang,

et al. 2024

Journal of Neurosurgical Anesthesiology

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Objective: Data on the impact of different anesthesia methods on clinical outcomes in patients with acute ischemic stroke undergoing endovascular therapy (EVT) in extended windows are limited. This study compared clinical outcomes in patients with stroke having general anesthesia (GA), conscious sedation (CS), or local anesthesia (LA) during EVT in extended (>6 h) time windows. Methods: We conducted an exploratory analysis of data from the ANGEL-ACT registry. The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included the proportions of patients with mRS scores of 0 to 1, 0 to 2, and 0 to 3, and safety outcomes were any intracranial hemorrhage (ICH), symptomatic ICH, or mortality within 90 days. Multivariate analyses, inverse probability of treatment weighting, and coarsened exact matching were used to adjust for indication bias. Results: A total of 646 patients were included in the analysis (GA,280; CS, 103; LA, 263). Patients having LA during EVT were more likely to have a favorable mRS score (adjusted odds ratio [aOR]: 1.75; 95% CI: 1.28 to 2.40) and a lower incidence of symptomatic ICH (aOR: 0.33; 95% CI: 0.14 to 0.76) than those having GA group. Similarly, CS was associated with greater odds of favorable 90-day mRS scores compared with GA (aOR: 1.69; 95% CI: 1.11 to 2.56). Posterior circulation stroke was overrepresented in the GA group (29.6%) and may be a reason for the worse outcomes in the GA group. Conclusions: Patients who received LA or CS had better neurological outcomes than those who received GA within extended time windows in a real-world setting.

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Anesthesia on Clinical Outcomes in an Extended Time Window During Endovascular Stroke Therapy: Exploratory Analysis of the ANGEL-ACT Registry

Wang,

Liang,

et al. 2024

Journal of Neurosurgical Anesthesiology

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Neurocritical Care Support of Endovascular Mechanical Thrombectomy

Tahsili-Fahadan,

Wang,

et al. 2024

Preprint

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Background Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality, where timely intervention with mechanical thrombectomy (MT) is crucial for restoring cerebral blood flow and improving patient outcomes. This study evaluates the impact of a dedicated Neurocritical Care Rapid Response Team (NCC-RRT) on MT workflow efficiency and patient outcomes. Methods We conducted a prospective analysis of AIS patients undergoing MT at a Comprehensive Stroke Center between January 2021 and December 2023. The study compared two periods: Era 1 (pre-NCC-RRT, January-October 2021) and Era 2 (post-NCC-RRT, December 2021-December 2023). The NCC-RRT was responsible for the expedited transfer, airway management, procedural analgosedation, and hemodynamic support. Key metrics, including door-to-groin-puncture (DTGP) and door-to-recanalization (DTR) times, were analyzed. Results A total of 395 patients were included in the study. The implementation of the NCC-RRT significantly reduced DTGP and DTR times, particularly in patients receiving general anesthesia (GA). The NCC-RRT was associated with a 14.3% reduction in groin-puncture-to-recanalization time and a 26.6% increase in GA utilization. Additionally, significant time reductions were observed in both direct ED presentations and transferred patients. Conclusions The introduction of a dedicated NCC-RRT led to substantial improvements in MT process efficiency, highlighting the critical role of neurocritical care in optimizing stroke treatment and enhancing patient outcomes. This model offers an effective alternative for centers where dedicated neuroanesthesia teams are unavailable.

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Answering the Call: The Case for Anesthesiologist-led Care for All Stroke Thrombectomies

Cited by 2 publications

References 10 publications

Anesthesia on Clinical Outcomes in an Extended Time Window During Endovascular Stroke Therapy: Exploratory Analysis of the ANGEL-ACT Registry

Anesthesia on Clinical Outcomes in an Extended Time Window During Endovascular Stroke Therapy: Exploratory Analysis of the ANGEL-ACT Registry

Neurocritical Care Support of Endovascular Mechanical Thrombectomy

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