From the Department of Radiology (W.B., H.J.C., D.F.K.), Department of Neurosurgery (W.B., D.F.K.), Department of Anesthesia (J.P., T.L.W.), Division of Preventive Medicine (M.H.M.), Knowledge and Evaluation Research Unit (M.H.M.), and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN.
Stroke. 2017 Oct;48(10):2784-2791. doi: 10.1161/STROKEAHA.117.017786. Epub 2017 Sep 13.
There is currently controversy on the ideal anesthesia strategy during mechanical thrombectomy for acute ischemic stroke. We performed a systematic review and meta-analysis of studies comparing clinical and angiographic outcomes of patients undergoing general anesthesia (GA group) and those receiving either local anesthesia or conscious sedation (non-GA group).
A literature search on anesthesia and endovascular treatment of acute ischemic stroke was performed. Using random-effects meta-analysis, we evaluated the following outcomes: recanalization rate, good functional outcome at 90 days (modified Rankin Score≤2), symptomatic intracranial hemorrhage, death, vascular complications, respiratory complications, procedure time, and time to groin puncture.
Twenty-two studies (3 randomized controlled trials and 19 observational studies), including 4716 patients (1819 GA and 2897 non-GA) were included. In the nonadjusted analysis, patients in the GA group had higher odds of death (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.66-2.45) and respiratory complications (OR, 1.70; 95% CI, 1.22-2.37) and lower odds of good functional outcome (OR, 0.58; 95% CI, 0.48-0.64) compared with the non-GA group. There was no difference in procedure time between the 2 primary comparison groups. When adjusting for baseline National Institutes of Health Stroke Scale, GA was still associated with lower odds of good functional outcome (OR, 0.59; 95% CI, 0.29-0.94). When considering studies performed in the stent-retriever/aspiration era, there was no significant difference in good neurological outcome rates (OR, 0.84; 95% CI, 0.67-1.06).
Acute ischemic stroke patients undergoing intra-arterial therapy may have worse outcomes when treated with GA as compared with conscious sedation/local anesthesia. However, major limitations of current evidence (ie, retrospective studies and selection bias) indicate a need for adequately powered, multicenter randomized controlled trials to answer this question.
目前，对于急性缺血性脑卒中机械取栓术的理想麻醉策略仍存在争议。我们对比较全身麻醉（GA 组）和局部麻醉或清醒镇静（非 GA 组）患者的临床和血管造影结局的研究进行了系统回顾和荟萃分析。
对麻醉和急性缺血性脑卒中血管内治疗的文献进行了检索。我们使用随机效应荟萃分析评估了以下结局：再通率、90 天的良好功能结局（改良 Rankin 评分≤2）、症状性颅内出血、死亡、血管并发症、呼吸并发症、手术时间和股动脉穿刺时间。
共纳入 22 项研究（3 项随机对照试验和 19 项观察性研究），包括 4716 例患者（1819 例 GA 组和 2897 例非 GA 组）。在未校正分析中，GA 组患者的死亡（比值比 [OR]，2.02；95%置信区间 [CI]，1.66-2.45）和呼吸并发症（OR，1.70；95%CI，1.22-2.37）的比值较高，而良好功能结局（OR，0.58；95%CI，0.48-0.64）的比值较低。两组之间的手术时间无差异。当调整基线国立卫生研究院卒中量表时，GA 仍与良好功能结局的可能性较低相关（OR，0.59；95%CI，0.29-0.94）。当考虑支架取栓/抽吸时代进行的研究时，良好的神经功能结局率无显著差异（OR，0.84；95%CI，0.67-1.06）。
与清醒镇静/局部麻醉相比，接受动脉内治疗的急性缺血性脑卒中患者接受 GA 治疗可能会有更差的结局。然而，当前证据的主要局限性（即回顾性研究和选择偏倚）表明，需要进行足够数量、多中心的随机对照试验来回答这个问题。
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