Neuroradiology, Aarhus University Hospital, Aarhus, Denmark.
Neurointervention, Texas Stroke Institute, Plano, Texas, USA.
J Neurointerv Surg. 2019 Nov;11(11):1070-1072. doi: 10.1136/neurintsurg-2019-014712. Epub 2019 Mar 29.
The "General or Local Anesthesia in Intra-Arterial Therapy" (GOLIATH) trial compared infarct growth and outcome in patients undergoing endovascular therapy (EVT) under either general anesthesia (GA) or conscious sedation (CS). The results were the same for the primary outcome (infarct growth) but successful reperfusion was higher in the GA arm.
To further examine differences in the quality and safety of EVT with the two anesthetic regimens in a post hoc analysis of GOLIATH.
In GOLIATH, 128 subjects with anterior circulation large vessel occlusion stroke within 6 hours of onset were randomized to either GA or CS (1:1 allocation). We compared the quality of reperfusion, treatment delay, use of catheters, and contrast and radiation dosage between the trial arms.
Sixty-five subjects were randomized to GA. Baseline demographic and clinical variables were similar between the treatment arms. We found no difference in procedure time, contrast dose, or radiation dose between the two arms. Tandem occlusions were associated with a longer procedure time, but there was no difference between the two arms. There was no difference in reperfusion rates between the direct aspiration technique and a stent retriever (86% vs 79%, respectively, p=0.54), but aspiration was associated with a shorter procedure time (28 min vs 42 min for a stent retriever), p=0.03.
Safety and quality of EVT under either GA and CS are comparable.
Unique identifier: NCT02317237;Post-results.
“全身麻醉与局部麻醉在动脉内治疗中的比较（GOLIATH）”试验比较了全麻（GA）和清醒镇静（CS）下接受血管内治疗（EVT）的患者的梗死灶进展和结局。主要结局（梗死灶进展）的结果相同，但 GA 组的再灌注成功率更高。
通过 GOLIATH 的事后分析，进一步研究两种麻醉方案下 EVT 的质量和安全性差异。
在 GOLIATH 试验中，128 例发病 6 小时内前循环大血管闭塞性卒中患者随机分为 GA 或 CS 组（1:1 分配）。我们比较了试验臂之间的再灌注质量、治疗延迟、导管使用以及对比剂和辐射剂量。
65 例患者被随机分配至 GA 组。治疗臂之间的基线人口统计学和临床变量相似。我们发现两组之间的手术时间、对比剂剂量或辐射剂量没有差异。串联闭塞与手术时间较长相关，但两组之间没有差异。直接抽吸技术与支架取栓之间的再灌注率无差异（分别为 86%和 79%，p=0.54），但抽吸与较短的手术时间相关（支架取栓为 42 分钟，直接抽吸为 28 分钟，p=0.03）。
GA 和 CS 下 EVT 的安全性和质量相当。
唯一标识符：NCT02317237；Post-results。
