麻醉对使用Solitaire支架取栓器进行血管内治疗的急性缺血性卒中预后的影响
Impact of Anesthesia on the Outcome of Acute Ischemic Stroke after Endovascular Treatment with the Solitaire Stent Retriever.
作者信息
Slezak A, Kurmann R, Oppliger L, Broeg-Morvay A, Gralla J, Schroth G, Mattle H P, Arnold M, Fischer U, Jung S, Greif R, Neff F, Mordasini P, Mono M-L
机构信息
From the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.).
Diagnostic and Interventional Neuroradiology (J.G., G.S., P.M.).
出版信息
AJNR Am J Neuroradiol. 2017 Jul;38(7):1362-1367. doi: 10.3174/ajnr.A5183. Epub 2017 May 4.
BACKGROUND AND PURPOSE
General anesthesia during endovascular treatment of acute ischemic stroke may have an adverse effect on outcome compared with conscious sedation. The aim of this study was to examine the impact of the type of anesthesia on the outcome of patients with acute ischemic stroke treated with the Solitaire stent retriever, accounting for confounding factors.
MATERIALS AND METHODS
Four-hundred one patients with consecutive acute anterior circulation stroke treated with a Solitaire stent retriever were included in this prospective analysis. Outcome was assessed after 3 months by the modified Rankin Scale.
RESULTS
One-hundred thirty-five patients (31%) underwent endovascular treatment with conscious sedation, and 266 patients (69%), with general anesthesia. Patients under general anesthesia had higher NIHSS scores on admission (17 versus 13, < .001) and more internal carotid artery occlusions (44.6% versus 14.8%, < .001) than patients under conscious sedation. Other baseline characteristics such as time from symptom onset to the start of endovascular treatment did not differ. Favorable outcome (mRS 0-2) was more frequent with conscious sedation (47.4% versus 32%; OR, 0.773; 95% CI, 0.646-0.925; = .002) in univariable but not multivariable logistic regression analysis ( = .629). Mortality did not differ ( = .077). Independent predictors of outcome were age (OR, 0.95; 95% CI, 0.933-0.969; < .001), NIHSS score (OR, 0.894; 95% CI, 0.855-0.933; < .001), time from symptom onset to the start of endovascular treatment (OR, 0.998; 95% CI, 0.996-0.999; = .011), diabetes mellitus (OR, 0.544; 95% CI, 0.305-0.927; = .04), and symptomatic intracerebral hemorrhage (OR, 0.109; 95% CI, 0.028-0.428; = .002).
CONCLUSIONS
In this single-center study, the anesthetic management during stent retriever thrombectomy with general anesthesia or conscious sedation had no impact on the outcome of patients with large-vessel occlusion in the anterior circulation.
背景与目的
与清醒镇静相比，急性缺血性卒中血管内治疗期间的全身麻醉可能对预后产生不利影响。本研究的目的是在考虑混杂因素的情况下，研究麻醉类型对使用Solitaire支架取栓器治疗的急性缺血性卒中患者预后的影响。
材料与方法
本前瞻性分析纳入了401例连续接受Solitaire支架取栓器治疗的急性前循环卒中患者。3个月后通过改良Rankin量表评估预后。
结果
135例患者（31%）在清醒镇静下接受血管内治疗，266例患者（69%）接受全身麻醉。与清醒镇静下的患者相比，全身麻醉下的患者入院时NIHSS评分更高（17分对13分，P<0.001），颈内动脉闭塞更多（44.6%对14.8%，P<0.001）。其他基线特征，如从症状发作到血管内治疗开始的时间，没有差异。在单变量但非多变量逻辑回归分析中，清醒镇静组的良好预后（mRS 0-2）更常见（47.4%对32%；OR，0.773；95%CI，0.646-0.925；P = 0.002）。死亡率没有差异（P = 0.077）。预后的独立预测因素为年龄（OR，0.95；95%CI，0.933-0.969；P<0.001）、NIHSS评分（OR，0.894；95%CI，0.855-0.933；P<0.001）、从症状发作到血管内治疗开始的时间（OR，0.998；95%CI，0.996-0.999；P = 0.011）、糖尿病（OR，0.544；95%CI，0.305-0.927；P = 0.04）和症状性脑出血（OR，0.109；95%CI，0.028-0.428；P = 0.002）。
结论
在这项单中心研究中，全身麻醉或清醒镇静下进行支架取栓术时的麻醉管理对前循环大血管闭塞患者的预后没有影响。
Zotero 插件