北美 SOLITAIRE 支架取栓急性脑卒中注册研究：麻醉选择与结果。
North American SOLITAIRE Stent-Retriever Acute Stroke Registry: choice of anesthesia and outcomes.
机构信息
From the Texas Stroke Institute, Plano, TX (A.A.-C., V.J.); Departments of Neurology, Neurosurgery, and Radiology, Medical College of Wisconsin/Froedtert Hospital, Atlanta, GA (O.O.Z., A.C.C., M.A.I.); Wellstar Neurosurgery Kennestone Hospital, Atlanta, GA (R.G.); Department of Neurology, Emory University School of Medicine, Atlanta, GA (C.-H.J.S. R.G.N.); Saint Luke's Kansas City, Kansas City, MO (C.O.M., W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K.); California Pacific Medical Center, San Francisco, CA (J.D.E.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Alexian Brothers Medical Center, Elk Grove Village, IL (T.W.M., F.A.M.); Oregon Health and Science University, Portland, OR (H.B.); Department of Neurology, Wayne State University School of Medicine, Detroit, MI (A.X.); Department of Radiology, West Virginia University Hospital, Morgantown, WV (A.T.R.); Departments of Neurology, Neurosurgery, Radiology, Vanderbilt University Medical Center, Nashville, TN (M.T.F.); Provena Saint Joseph Medical Center, Joliet, IL (A.B.); Departments of Neurology, Neurosurgery, Radiology, Boston Medical Center, Boston, MA (T.N.N.); Desert Regional Medical Center, Palm Springs, CA (M.T.); University of Kansas Medical Center, Kansas City, KS (M.G.A.); University of Texas Health Science Center, Houston, TX (H.S.); Departments of Radiology, Neurology, UT Southwestern Medical Center, Dallas, TX (R.N.); Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA (A.J.Y.); University of Texas, Houston, TX (P.R.C.); Department of Neurosurgery, Houston Methodist, Methodist Neurological Institute, Houston, TX (G.W.B.); Saint Louis University, St. Louis, MO (R.K.); and University of Missouri, Columbia, MO (A.N.).
出版信息
Stroke. 2014 May;45(5):1396-401. doi: 10.1161/STROKEAHA.113.003698. Epub 2014 Mar 25.
BACKGROUND AND PURPOSE
Previous work that predated the availability of the safer stent-retriever devices has suggested that general anesthesia (GA) may have a negative impact on outcomes in patients with acute ischemic stroke undergoing endovascular therapy.
METHODS
We reviewed demographic, clinical, procedural (GA versus local anesthesia [LA], etc), and site-adjudicated angiographic and clinical outcomes data from consecutive patients treated with the Solitaire FR device in the investigator-initiated North American SOLITAIRE Stent-Retriever Acute Stroke (NASA) Registry. The primary outcomes were 90-day modified Rankin Scale, mortality, and symptomatic intracranial hemorrhage.
RESULTS
A total of 281 patients from 18 centers were enrolled. GA was used in 69.8% (196/281) of patients. Baseline demographic and procedural factors were comparable between the LA and GA groups, except the former demonstrated longer time-to-groin puncture (395.4±254 versus 337.4±208 min; P=0.04), lower National Institutes of Health Stroke Scale (NIHSS; 16.2±5.8 versus 18.8±6.9; P=0.002), lower balloon-guide catheter usage (22.4% versus 49.2%; P=0.0001), and longer fluoroscopy times (39.5±33 versus 28±22.8 min; P=0.008). Recanalization (thrombolysis in cerebral infarction ≥2b; 72.94% versus 73.6%; P=0.9) and rate of symptomatic intracranial hemorrhage (7.1% versus 11.2%; P=0.4) were similar but modified Rankin Scale ≤2 was achieved in more LA patients, 52.6% versus 35.6% (odds ratio, 1.4 [1.1-1.8]; P=0.01). In multivariate analysis, hypertension, NIHSS, unsuccessful revascularization, and GA use (odds ratio, 3.3 [1.6-7.1]; P=0.001) were associated with death. When only anterior circulation and elective GA patients were included, there was a persistent difference in good outcomes in favor of LA patients (50.7% versus 35.5%; odds ratio, 1.3 [1.01-1.6]; P=0.04).
CONCLUSIONS
The NASA Registry has demonstrated that clinical outcomes and survival are significantly better in patients treated with LA, without increased symptomatic intracranial hemorrhage risk. Future trials should prospectively evaluate the effect of GA on outcomes.
背景与目的
在更安全的支架取栓装置问世之前的研究表明，全身麻醉（GA）可能对接受血管内治疗的急性缺血性脑卒中患者的结局产生负面影响。
方法
我们回顾了连续接受 Solitaire FR 装置治疗的患者的人口统计学、临床、手术（GA 与局部麻醉[LA]等）以及经站点裁决的血管造影和临床结局数据，这些数据来自于一项由研究者发起的北美 Solitaire 支架取栓急性脑卒中（NASA）登记研究。主要结局为 90 天改良 Rankin 量表评分、死亡率和症状性颅内出血。
结果
共纳入了来自 18 个中心的 281 名患者。GA 用于 69.8%（196/281）的患者。LA 组和 GA 组的基线人口统计学和手术因素相当，除了前者显示更长的股动脉穿刺时间（395.4±254 分钟比 337.4±208 分钟；P=0.04）、更低的国立卫生研究院卒中量表评分（NIHSS；16.2±5.8 分比 18.8±6.9 分；P=0.002）、更低的球囊导引导管使用率（22.4%比 49.2%；P=0.0001）和更长的透视时间（39.5±33 分钟比 28±22.8 分钟；P=0.008）。再通率（脑梗死溶栓分级≥2b；72.94%比 73.6%；P=0.9）和症状性颅内出血发生率（7.1%比 11.2%；P=0.4）相似，但更多的 LA 患者达到了改良 Rankin 量表≤2 级，52.6%比 35.6%（优势比，1.4[1.1-1.8]；P=0.01）。多变量分析显示，高血压、NIHSS、再通失败和 GA 使用（优势比，3.3[1.6-7.1]；P=0.001）与死亡相关。当仅纳入前循环和择期 GA 患者时，LA 患者的良好结局仍存在显著差异（50.7%比 35.5%；优势比，1.3[1.01-1.6]；P=0.04）。
结论
NASA 登记研究表明，接受 LA 治疗的患者临床结局和生存率显著更好，且症状性颅内出血风险无增加。未来的试验应前瞻性评估 GA 对结局的影响。
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