Department of Neurology.
Department of Anesthesiology, Amsterdam UMC Location AMC, University of Amsterdam.
Curr Opin Anaesthesiol. 2022 Aug 1;35(4):472-478. doi: 10.1097/ACO.0000000000001150. Epub 2022 Jul 5.
The introduction of clot removement by endovascular treatment (EVT) in 2015 has improved the clinical outcome of patients with acute ischemic stroke (AIS) due to a large vessel occlusion (LVO). Anesthetic strategies during EVT vary widely between hospitals, with some departments employing local anesthesia (LA), others performing conscious sedation (CS) or general anesthesia (GA). The optimal anesthetic strategy remains debated. This review will describe the effects of anesthetic strategy on clinical and radiological outcomes and hemodynamic parameters in patients with AIS undergoing EVT.
Small single-center randomized controlled trails (RCTs) found either no difference or favored GA, while large observational cohort studies favored CS or LA. RCTs using LA as separate comparator arm are still lacking and a meta-analysis of observational studies failed to show differences in functional outcome between LA vs. other anesthetic strategies. Advantages of LA were shorter door-to-groin time in patients and less intraprocedural hypotension, which are both variables that are known to impact functional outcome.
The optimal anesthetic approach in patients undergoing EVT for stroke therapy is still unclear, but based on logistics and peri-procedural hemodynamics, LA may be the optimal choice. Multicenter RCTs are warranted comparing LA, CS and GS with strict blood pressure targets and use of the same anesthetic agents to minimize confounding variables.
2015 年，血管内治疗（EVT）引入了血栓清除，这改善了因大血管闭塞（LVO）导致的急性缺血性脑卒中（AIS）患者的临床预后。EVT 期间的麻醉策略在医院之间差异很大，一些科室采用局部麻醉（LA），另一些科室则进行清醒镇静（CS）或全身麻醉（GA）。最佳麻醉策略仍存在争议。这篇综述将描述麻醉策略对接受 EVT 的 AIS 患者的临床和影像学结果以及血液动力学参数的影响。
小型单中心随机对照试验（RCT）发现 GA 没有差异或有利，而大型观察性队列研究则倾向于 CS 或 LA。仍缺乏使用 LA 作为单独比较组的 RCT，并且观察性研究的荟萃分析未能显示 LA 与其他麻醉策略之间在功能结局上的差异。LA 的优点是患者的门到腹股沟时间更短，术中低血压的发生率更低，这两个变量都已知会影响功能结局。
在接受 EVT 治疗脑卒中的患者中，最佳麻醉方法仍不清楚，但基于物流和围手术期血液动力学，LA 可能是最佳选择。需要进行多中心 RCT，比较 LA、CS 和 GS，同时设定严格的血压目标，并使用相同的麻醉剂，以尽量减少混杂变量。
