Abstract
BACKGROUND AND PURPOSE: A number of studies have suggested that anesthesia type (conscious sedation versus general anesthesia) during intra-arterial treatment for acute ischemic stroke has implications for patient outcomes. We performed a systematic review and meta-analysis of studies comparing the clinical and angiographic outcomes of the 2 anesthesia types.
MATERIALS AND METHODS: In March 2014, we conducted a computerized search of MEDLINE and EMBASE for reports on anesthesia and endovascular treatment of acute ischemic stroke. Using random-effects meta-analysis, we evaluated the following outcomes: recanalization rate, good functional outcome (mRS ≤ 2), asymptomatic and symptomatic intracranial hemorrhage, death, vascular complications, respiratory complications, procedure time, time to groin, and time from symptom onset to recanalization.
RESULTS: Nine studies enrolling 1956 patients (814 with general anesthesia and 1142 with conscious sedation) were included. Compared with patients treated by using conscious sedation during stroke intervention, patients undergoing general anesthesia had higher odds of death (OR = 2.59; 95% CI, 1.87–3.58) and respiratory complications (OR = 2.09; 95% CI, 1.36–3.23) and lower odds of good functional outcome (OR = 0.43; 95% CI, 0.35–0.53) and successful angiographic outcome (OR = 0.54; 95% CI, 0.37–0.80). No difference in procedure time (P = .28) was seen between the groups. Preintervention NIHSS scores were available from 6 studies; in those, patients receiving general anesthesia had a higher average NIHSS score.
CONCLUSIONS: Patients with acute ischemic stroke undergoing intra-arterial therapy may have worse outcomes with general anesthesia compared with conscious sedation. However, the difference in stroke severity at the onset may confound the comparison in the available studies; thus, a randomized trial is necessary to confirm this association.
ABBREVIATION:
- ICH
- intracranial hemorrhage
- © 2015 by American Journal of Neuroradiology
Jump to section
Related Articles
Cited By...
- Patients Requiring Conversion to General Anesthesia during Endovascular Therapy Have Worse Outcomes: A Post Hoc Analysis of Data from the SAGA Collaboration
- Choice of ANaesthesia for EndoVAScular treatment of acute ischaemic stroke at posterior circulation (CANVAS II): protocol for an exploratory randomised controlled study
- Management of acute ischemic stroke
- The impact of general anesthesia, baseline ASPECTS, time to treatment, and IV tPA on intracranial hemorrhage after neurothrombectomy: pooled analysis of the SWIFT PRIME, SWIFT, and STAR trials
- Emergency Conversion to General Anesthesia Is a Tolerable Risk in Patients Undergoing Mechanical Thrombectomy
- Safety and quality of endovascular therapy under general anesthesia and conscious sedation are comparable: results from the GOLIATH trial
- Equal performance of aspiration and stent retriever thrombectomy in daily stroke treatment
- Microcatheter navigation through the clot: does size matter?
- Current evidence for anesthesia management during endovascular stroke therapy: updated systematic review and meta-analysis
- Anaesthetic management during intracranial mechanical thrombectomy: systematic review and meta-analysis of current data
- Feasibility, Safety, and Periprocedural Complications Associated with Endovascular Treatment of Ruptured Intracranial Aneurysms according to the Depth of Anesthesia
- AHA/ASA 2018 AIS guidelines: impact and opportunity for endovascular stroke care
- Association of Blood Pressure With Short- and Long-Term Functional Outcome After Stroke Thrombectomy: Post Hoc Analysis of the SIESTA Trial
- Neuroendovascular management of emergent large vessel occlusion: update on the technical aspects and standards of practice by the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery
- Letter by Rasmussen et al Regarding Article, "Anesthesia-Related Outcomes for Endovascular Stroke Revascularization: A Systematic Review and Meta-Analysis"
- Wide Variability in Prethrombectomy Workflow Practices in the United States: A Multicenter Survey
- Anesthesia-Related Outcomes for Endovascular Stroke Revascularization: A Systematic Review and Meta-Analysis
- The Impact of Conscious Sedation versus General Anesthesia for Stroke Thrombectomy on the Predictive Value of Collateral Status: A Post Hoc Analysis of the SIESTA Trial
- Impact of Anesthesia on the Outcome of Acute Ischemic Stroke after Endovascular Treatment with the Solitaire Stent Retriever
- General Anesthesia Versus Conscious Sedation for Endovascular Treatment of Acute Ischemic Stroke: The AnStroke Trial (Anesthesia During Stroke)
- Mechanical thrombectomy in patients with M1 occlusion and NIHSS score <=5: a single-centre experience
- Admission systolic blood pressure and outcomes in large vessel occlusion strokes treated with endovascular treatment
- A survey of neurointerventionalists on thrombectomy practices for emergent large vessel occlusions
- Hemodynamics during anesthesia for intra-arterial therapy of acute ischemic stroke
- The effect of anesthetic management during intra-arterial therapy for acute stroke in MR CLEAN
- Mechanical thrombectomy with the Trevo ProVue device in ischemic stroke patients: does improved visibility translate into a clinical benefit?
- Third European Stroke Science Workshop
- Clinical Impact of Ventilation Duration in Patients with Stroke Undergoing Interventional Treatment under General Anesthesia: The Shorter the Better?
- 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
- Role of Anesthesia for Endovascular Treatment of Ischemic Stroke: Do We Need Neurophysiological Monitoring?
- Interventionalist Perspective on the New Endovascular Trials
- Type of Anesthesia and Differences in Clinical Outcome After Intra-Arterial Treatment for Ischemic Stroke