INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte Anne, Université Paris-Descartes, Paris, France.
Department of Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France.
J Neurol Neurosurg Psychiatry. 2019 Jan;90(1):68-74. doi: 10.1136/jnnp-2018-318549. Epub 2018 Sep 26.
Our aim was to compare the clinical outcome of patients with ischaemic stroke with anterior large vessel occlusion treated with stent retrievers and/or contact aspiration mechanical thrombectomy (MT) under general anaesthesia (GA) or conscious sedation non-GA through a systematic review and meta-analysis.
The literature was searched using PubMed, Embase and Cochrane databases to identify studies reporting on anaesthesia and MT. Using fixed or random weighted effect, we evaluated the following outcomes: 3-month mortality, modified Rankin Score (mRs) 0-2, recanalisation success (thrombolysis in cerebral infarction (TICI) ≥2b) and symptomatic intracerebral haemorrhagic (sICH) transformation.
We identified seven cohorts (including three dedicated randomised controlled trials), totalling 1929 patients (932 with GA). Over the entire sample, mortality, mRs 0-2, TICI≥2b and sICH rates were, respectively 17.5% (99% CI 9.7% to 29.6%; Q-value: 60.1; I: 93%, 1717 patients), 42.1% (99% CI 33.3% to 51.7%; Q-value: 41.3; I: 87.9%), 82.9% (99% CI 74.0% to 89.1%; Q-value: 20.7; I: 80.6%, 1006 patients) and 5.5% (99% CI 2.8% to 10.8%; Q-value: 18.6; I: 78.5%). MT performed in non-GA patients was associated with better 3-month functional outcome (pooled OR, 1.35; 99% CI 1.04 to 1.76; Q-value: 24.0; I: 9.2%, 1845 patients) and lower 3-month mortality rate (pooled OR, 0.70; 99% CI 0.49 to 0.98; Q-value: 1.4; I: 0%, 1717 patients; fixed weighted effect model) compared with GA. MT performed under conscious sedation non-GA had significantly shorter onset-to-recanalisation and onset-to-groin delay compared with GA, and recanalisation success and sICH were similar.
Non-GA during MT for anterior acute ischaemic stroke with current-generation stent retriever/aspiration devices is associated with better 3-month functional outcome and lower mortality rates. These unadjusted estimates are subject to biases and should be interpreted with caution.
通过系统评价和荟萃分析，比较在全身麻醉（GA）或非 GA 清醒镇静下接受支架取栓和/或接触抽吸机械血栓切除术（MT）治疗的急性前循环大血管闭塞缺血性脑卒中患者的临床结局。
使用 PubMed、Embase 和 Cochrane 数据库检索文献，以确定报告麻醉和 MT 的研究。使用固定或随机加权效应，我们评估了以下结局：3 个月死亡率、改良 Rankin 量表（mRs）评分 0-2、再通成功率（血栓溶解率[TICI]≥2b）和症状性颅内出血（sICH）转化。
我们确定了 7 个队列（包括 3 个专门的随机对照试验），共纳入 1929 名患者（GA 组 932 名）。在整个样本中，死亡率、mRs 评分 0-2、TICI≥2b 和 sICH 发生率分别为 17.5%（99%CI：9.7%至 29.6%；Q 值：60.1；I²：93%，1717 名患者）、42.1%（99%CI：33.3%至 51.7%；Q 值：41.3；I²：87.9%，1717 名患者）、82.9%（99%CI：74.0%至 89.1%；Q 值：20.7；I²：80.6%，1006 名患者）和 5.5%（99%CI：2.8%至 10.8%；Q 值：18.6；I²：78.5%）。非 GA 患者进行 MT 与更好的 3 个月功能结局（汇总 OR，1.35；99%CI：1.04 至 1.76；Q 值：24.0；I²：9.2%，1845 名患者）和更低的 3 个月死亡率（汇总 OR，0.70；99%CI：0.49 至 0.98；Q 值：1.4；I²：0%，1717 名患者；固定加权效应模型）相关。与 GA 相比，非 GA 下清醒镇静 MT 具有更短的发病至再通和发病至股动脉延迟时间，且再通成功率和 sICH 相似。
当前代支架取栓/抽吸装置治疗急性前循环缺血性脑卒中时，非 GA 与更好的 3 个月功能结局和更低的死亡率相关。这些未经调整的估计值存在偏倚，应谨慎解读。
