Impact of anesthetic strategy on outcomes for patients with acute basilar artery occlusion undergoing mechanical thrombectomy

Abstract

BackgroundThe best anesthetic management strategy for patients with acute large vessel occlusion treated with mechanical thrombectomy (MT) remains uncertain. Most studies have focused on anterior–circulation stroke caused by large artery occlusion. Nevertheless, limited data are available on the appropriate choice of anesthetic for acute basilar artery occlusion (BAO). We aimed to investigate the effect of anesthetic method on clinical outcomes in patients with BAO undergoing MT.MethodsPatients undergoing MT for acute BAO in the BASILAR registry (Acute Basilar Artery Occlusion Study) were included. We divided patients into three groups according to the anesthetic technique used during MT: general anesthesia (GA), local anesthesia (LA), and conscious sedation (CS). Propensity score matching was performed to achieve baseline balance.Results639 patients were included. GA was used in 257 patients (40.2%), LA was used in 250 patients (39.1%), and CS was used in 132 patients (20.7%). After 1:1 matching, favorable outcome, mortality, and hemorrhagic transformation rates, as well as modified Rankin Scale (mRS) score at 90 days, did not differ between the GA, LA, and CS groups.ConclusionsThe choice of anesthetic strategy, GA, LA, or CS, did not affect the clinical outcomes of patients with acute BAO treated with MT in the BASILAR registry.

General Anesthesia Versus Nongeneral Anesthesia for Patients With Acute Posterior Circulation Stroke Undergoing Endovascular Therapy: A Systematic Review and Meta-analysis

“…The sensitivity analysis showed that the data from studies focusing on functional independence, 90-day mortality, and successful reperfusion were relatively consistent (Supplemental Digital Content 7, http://links.lww.com/JNA/A560: Figure showing sensitivity analysis). Only 3 studies had minor inconsistencies in favorable outcome, but the estimated OR and border of 95% CI was very close to the combined result (Du et al16 OR: 0.71; 95% CI, 0.51 to 1.08; Li et al18 [GA vs. CS comparison] OR: 0.49; 95% CI, 0.20 to 1.16; Weyland et al21 OR: 0.57; 95% CI, 0.30 to 1.07; pooled results, OR: 0.55; 95% CI, 0.32 to 0.93). The low-quality, high risk bias RCT (Hu et al17) reported only the result of successful reperfusion and not the rate of functional independence, favorable outcome or 90-day mortality.…”

“…These 8 studies included 1777 patients and compared GA with non-GA in patients with acute posterior circulation stroke undergoing EVT (Table 1). Of the included studies, 1 was a case-control study,15 6 were cohort studies, and 1 was an RCT 16–22. There were 3 groups (GA, CS, and LA) in the study by Li et al,18 so we divided them into 2 groups for comparison (GA vs. CS and GA vs. LA).…”

“…Of the included studies, 1 was a case-control study, 15 6 were cohort studies, and 1 was an RCT. [16][17][18][19][20][21][22] There were 3 groups (GA, CS, and LA) in the study by Li et al, 18 so we divided them into 2 groups for comparison (GA vs. CS and GA vs. LA). The largest study included 639 patients (GA, n = 257; LA, n = 250; CS, n = 132), 18 and the smallest study included 100 patients (GA, n = 60; non-GA, n = 40).…”

“…[16][17][18][19][20][21][22] There were 3 groups (GA, CS, and LA) in the study by Li et al, 18 so we divided them into 2 groups for comparison (GA vs. CS and GA vs. LA). The largest study included 639 patients (GA, n = 257; LA, n = 250; CS, n = 132), 18 and the smallest study included 100 patients (GA, n = 60; non-GA, n = 40). 19 In the studies reporting these comorbidities, there was a history of hypertension in 66.2% (485/701) and 67.7% (452/665) of patients in the GA and non-GA groups, respectively, and a smoking history in 37…”

Betwixt and between: an idiomatic understanding of anesthesia in stroke intervention

“…Early retrospective studies demonstrated that CS was superior,1 but subsequent randomized controlled trials failed to show the superiority of one method 2–4. Current research continues to explore the best use of anesthesia in acute ischemic stroke therapy 5–8. While consensus does not exist on whether CS or GA is safer and/or more beneficial for stroke interventions, there are strong arguments to support having an anesthesia team involved in all mechanical thrombectomy procedures, whatever method is chosen.…”