Wang Xinyan, Liang Fa, Wu Youxuan, Jia Baixue, Zhang Xiaoli, Jian Minyu, Liu Haiyang, Wang Anxin, Miao Zhongrong, Han Ruquan
Department of Anesthesiology.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.
J Neurosurg Anesthesiol. 2025 Jan 1;37(1):64-69. doi: 10.1097/ANA.0000000000000959. Epub 2024 Mar 28.
Data on the impact of different anesthesia methods on clinical outcomes in patients with acute ischemic stroke undergoing endovascular therapy (EVT) in extended windows are limited. This study compared clinical outcomes in patients with stroke having general anesthesia (GA), conscious sedation (CS), or local anesthesia (LA) during EVT in extended (>6 h) time windows.
We conducted an exploratory analysis of data from the ANGEL-ACT registry. The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included the proportions of patients with mRS scores of 0 to 1, 0 to 2, and 0 to 3, and safety outcomes were any intracranial hemorrhage (ICH), symptomatic ICH, or mortality within 90 days. Multivariate analyses, inverse probability of treatment weighting, and coarsened exact matching were used to adjust for indication bias.
A total of 646 patients were included in the analysis (GA,280; CS, 103; LA, 263). Patients having LA during EVT were more likely to have a favorable mRS score (adjusted odds ratio [aOR]: 1.75; 95% CI: 1.28 to 2.40) and a lower incidence of symptomatic ICH (aOR: 0.33; 95% CI: 0.14 to 0.76) than those having GA group. Similarly, CS was associated with greater odds of favorable 90-day mRS scores compared with GA (aOR: 1.69; 95% CI: 1.11 to 2.56). Posterior circulation stroke was overrepresented in the GA group (29.6%) and may be a reason for the worse outcomes in the GA group.
Patients who received LA or CS had better neurological outcomes than those who received GA within extended time windows in a real-world setting.
关于不同麻醉方法对在延长时间窗内行血管内治疗（EVT）的急性缺血性脑卒中患者临床结局影响的数据有限。本研究比较了在延长（>6小时）时间窗内行EVT时接受全身麻醉（GA）、清醒镇静（CS）或局部麻醉（LA）的脑卒中患者的临床结局。
我们对ANGEL-ACT注册研究的数据进行了探索性分析。主要结局为90天时的改良Rankin量表（mRS）评分。次要结局包括mRS评分为0至1、0至2和0至3的患者比例，安全性结局为90天内任何颅内出血（ICH）、症状性ICH或死亡。采用多变量分析、治疗权重逆概率法和精确匹配法来调整指征偏倚。
共有646例患者纳入分析（GA组280例；CS组103例；LA组263例）。与GA组相比，EVT期间接受LA的患者更有可能获得良好的mRS评分（调整优势比[aOR]：1.75；95%置信区间[CI]：1.28至2.40），且症状性ICH发生率更低（aOR：0.33；95%CI：0.14至0.76）。同样，与GA组相比，CS组90天mRS评分良好的优势更大（aOR：1.69；95%CI：1.11至2.56）。GA组后循环卒中的比例过高（29.6%），这可能是GA组结局较差的一个原因。
在现实环境中，在延长时间窗内接受LA或CS的患者比接受GA的患者具有更好的神经学结局。
