Titre
Endovascular Treatment for Acute Ischemic Stroke With or Without General Anesthesia: A Matched Comparison.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Wagner, B.
Auteure/Auteur
Lorscheider, J.
Auteure/Auteur
Wiencierz, A.
Auteure/Auteur
Blackham, K.
Auteure/Auteur
Psychogios, M.
Auteure/Auteur
Bolliger, D.
Auteure/Auteur
De Marchis, G.M.
Auteure/Auteur
Engelter, S.T.
Auteure/Auteur
Lyrer, P.
Auteure/Auteur
Wright, P.R.
Auteure/Auteur
Fischer, U.
Auteure/Auteur
Mordasini, P.
Auteure/Auteur
Nannoni, S.
Auteure/Auteur
Puccinelli, F.
Auteure/Auteur
Kahles, T.
Auteure/Auteur
Bianco, G.
Auteure/Auteur
Carrera, E.
Auteure/Auteur
Luft, A.R.
Auteure/Auteur
Cereda, C.W.
Auteure/Auteur
Kägi, G.
Auteure/Auteur
Weber, J.
Auteure/Auteur
Nedeltchev, K.
Auteure/Auteur
Michel, P.
Auteure/Auteur
Gralla, J.
Auteure/Auteur
Arnold, M.
Auteure/Auteur
Bonati, L.H.
Auteure/Auteur
Contributrices/contributeurs
Anon, J.
Clarke, S.
Diepers, M.
Gruber, P.
Martin, E.
Remonda, L.
Schweikert, A.
Zupa, V.
Altersberger, V.
Brehm, A.
Dittrich, T.
El Mekabaty, A.
Fladt, J.
Fisch, U.
Gensicke, H.
Hert, L.
Manuzzi, S.
Maurer, M.
Meya, L.
Peters, N.
Polymeris, A.
Thilemann, S.
Traenka, C.
Tsogkas, I.
Zietz, A.
Goeldlin, M.
Heldner, M.
Jung, S.
Kaesmacher, J.
Mamaari, B.
Meinel, T.
Mueller, M.
Sarykaya, H.
Seiffge, D.
Siepen, B.
Vynkier, J.
Eskandari, A.
Pantazou, V.
Strambo, D.
Frangi, J.
Sihabdeen, S.
Vehoff, J.
Katan, M.
Mueller, A.
Wegener, S.
Groupes de travail
Swiss Stroke Registry Investigators
Liens vers les personnes
Liens vers les unités
ISSN
1524-4628
Statut éditorial
Publié
Date de publication
2022-05
Volume
53
Numéro
5
Première page
1520
Dernière page/numéro d’article
1529
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Résumé
Endovascular treatment in large artery occlusion stroke reduces disability. However, the impact of anesthesia type on clinical outcomes remains uncertain.
We compared consecutive patients in the Swiss Stroke Registry with anterior circulation stroke receiving endovascular treatment with or without general anesthesia (GA). The primary outcome was disability on the modified Rankin Scale after 3 months, analyzed with ordered logistic regression. Secondary outcomes included dependency or death (modified Rankin Scale score ≥3), National Institutes of Health Stroke Scale after 24 hours, symptomatic intracranial hemorrhage with ≥4 points worsening on National Institutes of Health Stroke Scale within 7 days, and mortality. Coarsened exact matching and propensity score matching were performed to adjust for indication bias.
One thousand two hundred eighty-four patients (GA: n=851, non-GA: n=433) from 8 Stroke Centers were included. Patients treated with GA had higher modified Rankin Scale scores after 3 months than patients treated without GA, in the unmatched (odds ratio [OR], 1.75 [1.42-2.16]; P<0.001), the coarsened exact matching (n=332-524, using multiple imputations of missing values; OR, 1.60 [1.08-2.36]; P=0.020), and the propensity score matching analysis (n=568; OR, 1.61 [1.20-2.15]; P=0.001). In the coarsened exact matching analysis, there were no significant differences in National Institutes of Health Stroke Scale after 1 day (estimated coefficient 2.61 [0.59-4.64]), symptomatic intracranial hemorrhage (OR, 1.06 [0.30-3.75]), dependency or death (OR, 1.42 [0.91-2.23]), or mortality (OR, 1.65 [0.94-2.89]). In the propensity score matching analysis, National Institutes of Health Stroke Scale after 24 hours (estimated coefficient, 3.40 [1.76-5.04]), dependency or death (OR, 1.49 [1.07-2.07]), and mortality (OR, 1.65 [1.11-2.45]) were higher in the GA group, whereas symptomatic intracranial hemorrhage did not differ significantly (OR, 1.77 [0.73-4.29]).
This large study showed worse functional outcome after endovascular treatment of anterior circulation stroke with GA than without GA in a real-world setting. This finding appears to be independent of known differences in patient characteristics between groups.
We compared consecutive patients in the Swiss Stroke Registry with anterior circulation stroke receiving endovascular treatment with or without general anesthesia (GA). The primary outcome was disability on the modified Rankin Scale after 3 months, analyzed with ordered logistic regression. Secondary outcomes included dependency or death (modified Rankin Scale score ≥3), National Institutes of Health Stroke Scale after 24 hours, symptomatic intracranial hemorrhage with ≥4 points worsening on National Institutes of Health Stroke Scale within 7 days, and mortality. Coarsened exact matching and propensity score matching were performed to adjust for indication bias.
One thousand two hundred eighty-four patients (GA: n=851, non-GA: n=433) from 8 Stroke Centers were included. Patients treated with GA had higher modified Rankin Scale scores after 3 months than patients treated without GA, in the unmatched (odds ratio [OR], 1.75 [1.42-2.16]; P<0.001), the coarsened exact matching (n=332-524, using multiple imputations of missing values; OR, 1.60 [1.08-2.36]; P=0.020), and the propensity score matching analysis (n=568; OR, 1.61 [1.20-2.15]; P=0.001). In the coarsened exact matching analysis, there were no significant differences in National Institutes of Health Stroke Scale after 1 day (estimated coefficient 2.61 [0.59-4.64]), symptomatic intracranial hemorrhage (OR, 1.06 [0.30-3.75]), dependency or death (OR, 1.42 [0.91-2.23]), or mortality (OR, 1.65 [0.94-2.89]). In the propensity score matching analysis, National Institutes of Health Stroke Scale after 24 hours (estimated coefficient, 3.40 [1.76-5.04]), dependency or death (OR, 1.49 [1.07-2.07]), and mortality (OR, 1.65 [1.11-2.45]) were higher in the GA group, whereas symptomatic intracranial hemorrhage did not differ significantly (OR, 1.77 [0.73-4.29]).
This large study showed worse functional outcome after endovascular treatment of anterior circulation stroke with GA than without GA in a real-world setting. This finding appears to be independent of known differences in patient characteristics between groups.
PID Serval
serval:BIB_24045482D0D2
PMID
Open Access
Oui
Date de création
2022-04-09T17:37:29.609Z
Date de création dans IRIS
2025-05-20T19:46:55Z
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35341319_BIB_24045482D0D2.pdf
Version du manuscrit
published
Licence
https://creativecommons.org/licenses/by/4.0
Taille
624.89 KB
Format
Adobe PDF
PID Serval
serval:BIB_24045482D0D2.P001
URN
urn:nbn:ch:serval-BIB_24045482D0D26
Somme de contrôle
(MD5):803479b1ecb236a666e3b495bf8451e6