Is general anaesthesia preferable to conscious sedation in the treatment of acute ischaemic stroke with intra-arterial mechanical thrombectomy? A review of the literature

John, Nevin; Mitchell, Peter; Dowling, Richard; Yan, Bernard

doi:10.1007/s00234-012-1084-y

Cited by 40 publications

(36 citation statements)

References 41 publications

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“…Retrospective analyses of the hemodynamic parameters of patients underwent mechanical recanalization for AIS found that GA was associated with a lower minimum systolic, diastolic, and mean blood pressure than MAC, and that higher systolic blood pressure was associated with better outcomes (21). Other studies, however, have not found significant trends in hemodynamic variation between GA and MAC (16).…”

Section: The Potential Benefits Of Monitored Anesthesia Care: Why?mentioning

confidence: 76%

“…For example, one multicenter study showed that GA was associated with worse functional outcomes as assessed by the mRS than monitored anesthesia care (MAC), based on data from 980 patients who underwent mechanical recanalization (13). Other retrospective studies have come to similar conclusions, with GA associated with worse functional outcomes (i.e., a mRS score >2) (14,15), parenchymal hemorrhage (16), and higher in-hospital mortality (16). A recent metaanalysis of nine studies with 1956 patients found that GA had a lower odds ratio (OR) for good functional outcome (OR= 0.43; P<0.01) and successful recanalization (OR=0.49; P< 0.01), and a higher OR for mortality (OR=2.59; P<0.01) and respiratory complications (OR= 2.09; P<0.01) (17).…”

Section: General Anesthesia Versus Monitored Anesthesia Care For Mechmentioning

confidence: 98%

“…Indeed, in many of these retrospective studies, patients receiving GA had higher pre-procedural National Institutes of Health Stroke Scale (NI-HSS) scores, indicating that they had more symptomatic strokes prior to endovascular intervention (13)(14)(15). The difference in baseline neurological status is an independent predictor of worse outcomes, including death (14,16). However, the association between anesthesia technique and outcomes still remains after correcting for baseline stroke severity (NIHSS score) (14,16).…”

Section: General Anesthesia Versus Monitored Anesthesia Care For Mechmentioning

confidence: 99%

“…The difference in baseline neurological status is an independent predictor of worse outcomes, including death (14,16). However, the association between anesthesia technique and outcomes still remains after correcting for baseline stroke severity (NIHSS score) (14,16).…”

Section: General Anesthesia Versus Monitored Anesthesia Care For Mechmentioning

confidence: 99%

See 3 more Smart Citations

Anesthetic Care for Acute Ischemic Stroke: Facts and Aspirations

Lu¹,

McDonagh²,

Meng³

2015

J Anesth Perioper Med

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Section: The Potential Benefits Of Monitored Anesthesia Care: Why?mentioning

confidence: 76%

Section: General Anesthesia Versus Monitored Anesthesia Care For Mechmentioning

confidence: 98%

Section: General Anesthesia Versus Monitored Anesthesia Care For Mechmentioning

confidence: 99%

Section: General Anesthesia Versus Monitored Anesthesia Care For Mechmentioning

confidence: 99%

See 2 more Smart Citations

Anesthetic Care for Acute Ischemic Stroke: Facts and Aspirations

Lu¹,

McDonagh²,

Meng³

2015

J Anesth Perioper Med

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“…It is important to remember that endovascular thrombectomy requires general anaesthetic, although some recent studies have shown that it is preferable to carry out the procedure using conscious sedation 31,32 . Despite the potential efficacy of endovascular treatment, in particular using the stent retriever technology that results in higher rates of optimal perfusion, its higher cost compared to other technologies 33 adds to the challenge of the use of this new technology and further studies are needed to prove its cost-effectiveness.…”

Section: Possible Limitationsmentioning

confidence: 99%

Endovascular thrombectomy for the treatment of acute ischemic stroke

Ferri

Buehler

Flato

et al. 2015

Arq. Neuro-Psiquiatr.

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Few patients benefit from the current standard treatment for acute ischemic stroke (AIS), encouraging the development of new treatments. Objective To systematically review the literature on the efficacy and/or safety of endovascular thrombectomy in AIS compared to standard treatment and to identify ongoing randomized controlled trials (RCTs). Method Searches for RCTs were performed in Medline/Embase, and for ongoing trials: International Clinical Trial Registry Platform, Clinicaltrials.gov and ISRCTN registry (to June 15th, 2015). Results From the eight published RCTs, five showed the superiority of treatment that includes thrombectomy compared to standard care alone. From the 13 ongoing RCTs, 3 have been halted, one has not started, one has unknown status and eight will end between 2016 - 2020. Conclusion Evidence favours a combination of the standard therapy with endovascular thrombectomy. The selection criteria however limit the number of people who can benefit. Further studies are needed to prove its cost-effectiveness.

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Anesthesia for endovascular treatment in anterior circulation stroke: A systematic review and meta‐analysis

et al. 2018

Brain and Behavior

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BackgroundEndovascular treatment in patients with acute anterior circulation stroke could be performed under either conscious sedation (CS) or general anesthesia (GA). Although several studies have investigated the association between the clinical outcomes and the two anesthesia methods, consensus is lacking.MethodsPubMed and EMBASE searches were used to select full‐text articles comparing the effects of GA and CS on functional outcome and complications in patients with anterior circulation ischemic stroke. Enrolled patients were assigned to receive endovascular treatment with CS or GA, with a primary outcome of functional independency within 90 days. Secondary outcomes included intracranial hemorrhage, all‐cause mortality at 90 days, pneumonia, and intraprocedural complications.ResultsThirteen studies (3 RCTs and 10 observational studies), which included 3,857 patients (CS = 2,129, GA = 1,728), were eligible for the analysis. The overall analysis including the RCTs and observational studies demonstrated that the functional independence within 90 days occurred more frequently among patients with CS compared with GA (OR, 1.42; 95% CI, 1.05–1.92, p = 0.02); and the risk of mortality was higher with GA compared with CS; furthermore, CS was associated with lower rate of intracranial hemorrhage. In RCTs, GA was associated with increased functional independence (OR, 0.55; 95% CI, 0.34–0.89, p = 0.01) and successful reperfusion (OR, 0.51; 95% CI, 0.30–0.89, p = 0.02).ConclusionsIn the overall analysis and observational studies, CS was associated with improved functional outcomes and relatively safe for anterior ischemic stroke compared with GA. While the pooled data from RCTs suggested that GA was associated with improved outcomes. The inconsistency indicated that more large‐scale RCTs are required to evaluate what factors influenced the effect of the anesthesia methods on clinical outcomes.

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Is general anaesthesia preferable to conscious sedation in the treatment of acute ischaemic stroke with intra-arterial mechanical thrombectomy? A review of the literature

Abstract: Intra-arterial mechanical thrombectomy under general anaesthesia is associated with poor outcomes in observational studies. It is reasonable to offer conscious sedation as the preferred option where adverse patient factors such as agitation are lacking.

Cited by 40 publications

References 41 publications

Anesthetic Care for Acute Ischemic Stroke: Facts and Aspirations

Anesthetic Care for Acute Ischemic Stroke: Facts and Aspirations

Endovascular thrombectomy for the treatment of acute ischemic stroke

Anesthesia for endovascular treatment in anterior circulation stroke: A systematic review and meta‐analysis

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