General Anesthesia Versus Conscious Sedation and Local Anesthesia During Thrombectomy for Acute Ischemic Stroke

被引：57

作者：

Cappellari, Manuel ^{[1
]}

Pracucci, Giovanni ^{[2
]}

Forlivesi, Stefano ^{[1
]}

Saia, Valentina ^{[3
]}

Nappini, Sergio ^{[4
]}

Nencini, Patrizia ^{[4
]}

Inzitari, Domenico ^{[2
]}

Greco, Laura ^{[5
,6
]}

Sallustio, Fabrizio ^{[5
,6
]}

Vallone, Stefano ^{[7
,8
]}

Bigliardi, Guido ^{[7
,8
]}

Zini, Andrea ^{[9
,10
]}

Pitrone, Antonio ^{[11
,12
]}

Grillo, Francesco ^{[11
,12
]}

Musolino, Rosa ^{[11
,12
]}

Bracco, Sandra ^{[13
,14
]}

Tinturini, Rebecca ^{[13
,14
]}

Tassi, Rossana ^{[13
,14
]}

Bergui, Mauro ^{[15
,16
]}

Cerrato, Paolo ^{[15
,16
]}

Saletti, Andrea ^{[17
,18
]}

De Vito, Alessandro ^{[17
,18
]}

Casetta, Ilaria ^{[17
,18
]}

Gasparotti, Roberto ^{[19
,20
]}

Magoni, Mauro ^{[19
,20
]}

Castellan, Lucio ^{[21
,22
]}

Malfatto, Laura ^{[21
,22
]}

Menozzi, Roberto ^{[23
,24
]}

Scoditti, Umberto ^{[23
,24
]}

Causin, Francesco ^{[25
,26
]}

Baracchini, Claudio ^{[25
,26
]}

Puglielli, Edoardo ^{[27
,28
]}

Casalena, Alfonsina ^{[27
,28
]}

Ruggiero, Maria ^{[29
,30
]}

Malatesta, Emanuele ^{[29
,30
]}

Comelli, Chiara ^{[31
,32
]}

Chianale, Gigliola ^{[31
,32
]}

Lauretti, Dario Luca ^{[33
,34
]}

Mancuso, Michelangelo ^{[33
,34
]}

Lafe, Elvis ^{[35
]}

Cavallini, Anna ^{[36
]}

Cavasin, Nicola ^{[37
,38
]}

Critelli, Adriana ^{[37
,38
]}

Ciceri, Elisa Francesca Maria ^{[1
]}

Bonetti, Bruno ^{[1
]}

Chiumarulo, Luigi ^{[39
,40
]}

Petruzzelli, Marco ^{[39
,40
]}

Giorgianni, Andrea ^{[41
,42
]}

Versino, Maurizio ^{[41
,42
]}

Ganimede, Maria Porzia ^{[43
,44
]}

机构：

[1] Azienda Osped Univ Integrata, Neurosci Dept, Verona, Italy

[2] Univ Florence, NEUROFARBA Dept, Florence, Italy

[3] Santa Corona Hosp, Neurol & Stroke Unit, Pietra Ligure, Italy

[4] Careggi Univ Hosp, NEUROFARBA Dept, Florence, Italy

[5] Policlin Tor Vergata, Intervent Neuroradiol Unit, Rome, Italy

[6] Policlin Tor Vergata, Stroke Unit, Rome, Italy

[7] S Agostino Estense Univ Hosp, Osped Civile, Intervent Neuroradiol Unit, Modena, Italy

[8] S Agostino Estense Univ Hosp, Osped Civile, Stroke Unit, Modena, Italy

[9] Maggiore Hosp, Dept Neurol, Bologna, Italy

[10] Maggiore Hosp, Inst Neurol Sci, IRCCS, Stroke Ctr, Bologna, Italy

[11] Policlin G Martino, Intervent Neuroradiol Unit, Messina, Italy

[12] Policlin G Martino, Stroke Unit, Messina, Italy

[13] Osped S Maria Scotte Univ Hosp, Intervent Neuroradiol Unit, Siena, Italy

[14] Osped S Maria Scotte Univ Hosp, Stroke Unit, Siena, Italy

[15] Citta Salute Sci Molinette, Intervent Neuroradiol Unit, Turin, Italy

[16] Citta Salute Sci Molinette, Stroke Unit, Turin, Italy

[17] Arcispedale S Anna Univ Hosp, Neuroradiol Unit, Ferrara, Italy

[18] Arcispedale S Anna Univ Hosp, Stroke Unit, Ferrara, Italy

[19] Spedali Civil Brescia, Neuroradiol Unit, Brescia, Italy

[20] Spedali Civil Brescia, Stroke Unit, Brescia, Italy

[21] IRCCS San Martino IST, Intervent Neuroradiol Unit, Genoa, Italy

[22] IRCCS San Martino IST, Stroke Unit, Genoa, Italy

[23] Osped Univ, Intervent Neuroradiol Unit, Parma, Italy

[24] Osped Univ, Stroke Unit, Parma, Italy

[25] Azienda Osped Univ, Intervent Neuroradiol Unit, Padua, Italy

[26] Azienda Osped Univ, Stroke Unit, Padua, Italy

[27] Osped Civile Mazzini, Vasc & Intervent Radiol Unit, Teramo, Italy

[28] Osped Civile Mazzini, Neurol Unit, Teramo, Italy

[29] Osped Gen Provinciale M Bufalini, Neuroradiol Unit, Cesena, Italy

[30] Osped Gen Provinciale M Bufalini, Neurol Unit, Cesena, Italy

[31] Osped San Giovanni Bosco, Intervent Neuroradiol Unit, Turin, Italy

[32] Osped San Giovanni Bosco, Neurol Unit, Turin, Italy

[33] Osped Cisanello, Neuroradiol Unit, Pisa, Italy

[34] Osped Cisanello, Neurol Unit, Pisa, Italy

[35] Policlin IRCCS San Matteo, Radiol Diagnost & Intervent Neuroradiol Unit, Pavia, Italy

[36] IRCCS Mondino Fdn, Cerebrovasc Dept, Pavia, Italy

[37] Osped Angelo ULSS3 Serenissima, Neuroradiol Unit, Venice, Italy

[38] Osped Angelo ULSS3 Serenissima, Neurol Unit, Venice, Italy

[39] Azienda Osped Univ Policlin, Intervent Neuroradiol Unit, Bari, Italy

[40] Azienda Osped Univ Policlin, Stroke Unit, Bari, Italy

[41] Osped Univ Circolo ASST Sette Laghi, Neuroradiol Unit, Varese, Italy

[42] Osped Univ Circolo ASST Sette Laghi, Neurol Unit, Varese, Italy

[43] Osped SS Annunziata, Intervent Neuroradiol Unit, Taranto, Italy

[44] Osped SS Annunziata, Stroke Unit, Taranto, Italy

[45] Azienda Ospedaliera Annunziata, Intervent Neuroradiol Unit, Cosenza, Italy

[46] Azienda Ospedaliera Annunziata, Neurol Unit, Cosenza, Italy

[47] Sapienza Univ Hosp, Intervent Neuroradiol Unit, Rome, Italy

[48] Sapienza Univ Hosp, Stroke Unit, Rome, Italy

[49] Presidio Osped SS, Intervent Neuroradiol Unit, Avezzano, Italy

[50] Presidio Osped SS, Stroke Unit, Avezzano, Italy

来源：

STROKE | 2020年 / 51卷 / 07期

关键词：

anesthesia; conscious sedation; groin; odds ratio; thrombectomy; SYMPTOMATIC INTRACEREBRAL HEMORRHAGE; ENDOVASCULAR THROMBECTOMY; SICH NOMOGRAM; OUTCOMES; METAANALYSIS; THERAPY; TRIAL;

D O I：

10.1161/STROKEAHA.120.028963

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose: As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA). Methods: We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Results: GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0-1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602-1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515-0.990). The rates of modified Rankin Scale score of 0-2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689-1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566-0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644-1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844-1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262-0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337-0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of <1, antiplatelet, and anticoagulant), differences were found also between GA versus CS as regards modified Rankin Scale score of 0-2 (aOR, 0.659 [95% CI, 0.538-0.807]) and GA versus LA as regards death (aOR, 1.413 [95% CI, 1.095-1.823]). Conclusions: GA during thrombectomy was associated with worse 3-month functional outcomes, especially when compared with LA. The inclusion of an LA arm in future randomized clinical trials of anesthesia strategy is recommended.

引用

页码：2036 / 2044

页数：9

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