Wu Longfei, Jadhav Ashutosh P, Chen Jian, Sun Chenghe, Ji Kangxiang, Li Weili, Zhao Wenbo, Li Chuanhui, Wu Chuanjie, Wu Di, Ji Xunming
Department of Neurology and China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Neurol Sci. 2020 Sep 15;416:117045. doi: 10.1016/j.jns.2020.117045. Epub 2020 Jul 16.
The optimal anesthetic approach during endovascular therapy (EVT) in acute stroke patients remains an area of uncertainty. We investigated the impact of different anesthetic approaches on the outcome of posterior circulation stroke (PCS) patients undergoing EVT.
For this observational study, we enrolled consecutive PCS patients who underwent EVT from December 2012 to December 2018, and compared functional outcomes at 90 days as well as long-term follow-up in patients treated under local anesthesia (LA) versus general anesthesia (GA). Multivariable logistic regression and propensity score matched analyses were conducted.
Among the 183 patients included in this study, 71 patients (38.8%) received LA and 112 patients (61.2%) received GA. Median modified Rankin Scale score at 90 days was 4 (IQR, 2-6) in both groups (P = .956). No significant differences in the rates of functional independence and mortality at 90 days as well as long-term follow-up post intervention were observed between the two groups, and Kaplan-Meier survival analysis showed comparable long-term survival probabilities. Safety outcomes (including procedure-related complications and serious adverse events) did not differ between these patients. The anesthetic approach was neither associated with functional independence nor associated with mortality. Propensity score matched analysis indicated similar results.
For PCS patients undergoing EVT, LA compared with GA does not seem to result in different functional outcomes and complications rates.
急性卒中患者血管内治疗（EVT）期间的最佳麻醉方法仍是一个不确定的领域。我们研究了不同麻醉方法对接受EVT的后循环卒中（PCS）患者结局的影响。
在这项观察性研究中，我们纳入了2012年12月至2018年12月期间连续接受EVT的PCS患者，并比较了局部麻醉（LA）与全身麻醉（GA）下治疗患者90天时的功能结局以及长期随访情况。进行了多变量逻辑回归和倾向评分匹配分析。
本研究纳入的183例患者中，71例（38.8%）接受LA，112例（61.2%）接受GA。两组90天时改良Rankin量表评分中位数均为4（IQR，2 - 6）（P = 0.956）。两组在90天时以及干预后的长期随访中，功能独立率和死亡率均无显著差异，Kaplan-Meier生存分析显示长期生存概率相当。这些患者的安全结局（包括与手术相关的并发症和严重不良事件）无差异。麻醉方法既与功能独立无关，也与死亡率无关。倾向评分匹配分析表明结果相似。
对于接受EVT的PCS患者，与GA相比，LA似乎不会导致不同的功能结局和并发症发生率。
