Endovascular therapy for acute ischemic stroke: The importance of blood pressure control, sedation modality and anti-thrombotic management to improve functional outcomes

Robichon, Erwan; Maïer, Benjamin; Mazighi, Mikaël

doi:10.1016/j.neurol.2021.09.012

Cited by 7 publications

(2 citation statements)

References 71 publications

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“…We evaluated blood pressure at admission since it is a predictor of a less favorable functional outcome after MT [46][47][48] and is also related to the risk of procedural complications such as subarachnoid and intracerebral hemorrhage [49][50][51]. Our results were not in accordance with these studies, probably due to the selected cut-off value of SBP (140 mmHg).…”

Section: Discussionmentioning

confidence: 61%

The Presence of Communicating Arteries in the Circle of Willis Is Associated with Higher Rate of Functional Recovery after Anterior Circulation Ischemic Stroke

Sablić,

Dolić,

Kraljević

et al. 2023

Biomedicines

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Acute ischemic stroke (AIS) is the world’s second leading cause of mortality. An established method for treating stroke patients in acute settings is endovascular therapy (EVT). However, the correlation of the successful endovascular treatment of AIS with the presence of communicating arteries in the circle of Willis needs to be proven. Our study examined clinical and radiological data of 158 consecutive patients treated with mechanical thrombectomy (MT) at our comprehensive stroke center. We analyzed their CT angiograms and digital subtraction angiography (DSA) to assess anatomical variants of Willis’ circle and formed two groups—collateral-negative and collateral-positive group. The first group included patients with aplasia of both anterior (ACoA) and posterior communicating Artery (PCoA). The second group included patients that have at least one communicating artery (either anterior or posterior). We evaluated their reperfusion outcomes and functional recovery three months later. Our results showed that patients with communicating arteries had smaller areas of infarction on post-interventional CT and higher rates of functional recovery (Modified Rankin Score). The ACoA had a higher impact on early and late outcomes, confirmed by lower control CT scores and more favorable functional recovery. Therefore, anatomic variants of Willis’ circle should be considered as a significant prognostic factor in AIS.

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Section: Discussionmentioning

confidence: 61%

The Presence of Communicating Arteries in the Circle of Willis Is Associated with Higher Rate of Functional Recovery after Anterior Circulation Ischemic Stroke

Sablić,

Dolić,

Kraljević

et al. 2023

Biomedicines

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“…Due to the better procedural circumstances given by patient immobilization and controlled apnea during GA, the GA group saw a greater rate of recanalization. Additionally, the benefits of GA, such as the monitoring of physiological parameters for oxygenation and hemodynamics, may help improve EVT recanalization rates (26). However, some scholars further proposed that the prognosis evaluation factors of EVT for AIS are more complex, and intraoperative arterial hypotension recurrence is associated with changes in neurologic prognosis after acute ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

The effect of general anesthesia and conscious sedation in endovascular thrombectomy for acute ischemic stroke: an updated meta-analysis of randomized controlled trials and trial sequential analysis

Peng,

Luo,

Yan

et al. 2023

Front. Neurol.

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ObjectivesGeneral anesthesia (GA) and conscious sedation (CS) are common methods for endovascular thrombectomy (EVT) in acute ischemic stroke (AIS). However, the risks and benefits of each strategy are unclear. This study aimed to summarize the latest RCTs and compare the postoperative effects of the two methods on EVT patients.Materials and methodsWe systematically searched the database for GA and CS in AIS patients during EVT. The retrieval time was from the creation of the database until March 2023. The quality of the studies was evaluated using the Cochrane risk of bias tool. Random-effects or fixed-effects meta-analyses were used to assess all outcomes.ResultsWe preliminarily identified 304 studies, of which 8 were included. Based on the pooled estimates, there were no significant differences between the GA group and the CS group in terms of good functional outcomes (mRS0-2) and mortality rate at 3 months (RR = 1.09, 95% CI: 0.95–1.24, p = 0.23) (RR = 0.95, 95% CI: 0.75–1.22, p = 0.70) as well as in NHISS at 24 h after treatment (SMD = −0.01, 95% CI: −0.13 to 0.11, p = 0.89). However, the GA group had better outcomes in terms of achieving successful recanalization of the blood vessel (RR = 1.13, 95% CI: 1.07–1.19, p < 0.0001). The RR value for the risk of hypotension was 1.87 (95% CI: 1.42–2.47, p < 0.00001); for pneumonia, RR was 1.43 (95% CI: 1.07–1.90, p = 0.01); and for symptomatic intracerebral hemorrhage, RR was 0.94 (95% CI: 0.74–1.26, p = 0.68). The pooled RR value for complications after intervention was 1.03 (95% CI, 0.87–1.22, p = 0.76).ConclusionIn patients undergoing EVT for AIS, GA, and CS are associated with similar rates of functional independence. Further trials of a larger scale are needed to confirm these findings.

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Discovery of anti-stroke active substances in Guhong injection based on multi-phenotypic screening of zebrafish

Wang

Sheng

et al. 2022

Biomedicine & Pharmacotherapy

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Endovascular therapy for acute ischemic stroke: The importance of blood pressure control, sedation modality and anti-thrombotic management to improve functional outcomes

Cited by 7 publications

References 71 publications

The Presence of Communicating Arteries in the Circle of Willis Is Associated with Higher Rate of Functional Recovery after Anterior Circulation Ischemic Stroke

The Presence of Communicating Arteries in the Circle of Willis Is Associated with Higher Rate of Functional Recovery after Anterior Circulation Ischemic Stroke

The effect of general anesthesia and conscious sedation in endovascular thrombectomy for acute ischemic stroke: an updated meta-analysis of randomized controlled trials and trial sequential analysis

Discovery of anti-stroke active substances in Guhong injection based on multi-phenotypic screening of zebrafish

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