Passer Joel, Maurer Robert, Erkmen Kadir
Neurosurgery, Temple University Hospital, Philadelphia, USA.
Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, USA.
Cureus. 2019 Oct 3;11(10):e5831. doi: 10.7759/cureus.5831.
Background Type of sedation (conscious sedation (CS) or general anesthesia (GA)) during Intra-arterial mechanical thrombectomy (IAMT) for treatment of acute ischemic stroke may affect patient outcomes. Previous studies suggested that CS cohorts have a higher probability of good outcome than GA cohorts. However, CS cohorts had lower initial NIH stroke scores (NIHSS). This study offers an investigation into outcomes after IAMT based on sedation type. Methods Patients at our institution who underwent IAMT for treatment of acute ischemic stroke caused by anterior circulation occlusion between 2013-2015 were included in the study. Primary endpoint was functional outcome on the modified Rankin Scale (mRS) at 90 days post-IAMT. Secondary endpoints included NIHSS at 48 hours post-IAMT, time from CT scan to puncture and from puncture to initial recanalization, recanalization as defined by the Thrombolysis in Cerebral Ischemia (TICI) score, intensive care and hospital length of stay, and all-cause in-hospital mortality. Results Thirty nine patients were included in analysis; 17 received GA and 22 received CS. Cohorts were similar in baseline characteristics, including NIHSS. The 90-day mRS was not significantly different between cohorts, as was the case for most secondary endpoints. Successful recanalization was higher in both groups than previously reported and a significantly higher TICI 3 recanalization rate was achieved in the GA cohort. Conclusions We show that equal outcomes are possible with either CS or GA if initial NIHSS is comparable. It seems reasonable for neuro-interventionalists to continue practicing using their personal preference for sedation. However, prospective randomized trials are still needed.
在急性缺血性卒中的动脉内机械取栓术（IAMT）期间，镇静类型（清醒镇静[CS]或全身麻醉[GA]）可能会影响患者的预后。既往研究表明，与全身麻醉组相比，清醒镇静组有更好预后的可能性更高。然而，清醒镇静组的初始美国国立卫生研究院卒中量表（NIHSS）得分较低。本研究基于镇静类型对动脉内机械取栓术后的预后进行了调查。方法：纳入2013年至2015年间在我院因前循环闭塞导致急性缺血性卒中而接受动脉内机械取栓术的患者。主要终点是动脉内机械取栓术后90天改良Rankin量表（mRS）的功能预后。次要终点包括动脉内机械取栓术后48小时的NIHSS、从CT扫描到穿刺以及从穿刺到初始再通的时间、根据脑缺血溶栓（TICI）评分定义的再通情况、重症监护和住院时间以及全因院内死亡率。结果：39例患者纳入分析；17例接受全身麻醉，22例接受清醒镇静。两组在包括NIHSS在内的基线特征方面相似。两组之间90天mRS无显著差异，大多数次要终点也是如此。两组的成功再通率均高于既往报道，全身麻醉组的TICI 3级再通率显著更高。结论：我们表明，如果初始NIHSS相当，清醒镇静或全身麻醉都可能有相同的预后。神经介入医生继续根据个人对镇静的偏好进行操作似乎是合理的。然而，仍需要前瞻性随机试验。
