伴有或不伴有全身麻醉的孤立性大脑后动脉闭塞性卒中的血管内治疗

Endovascular therapy of isolated posterior cerebral artery occlusion stroke with and without general anesthesia.

作者信息

Berberich Anne, Herweh Christian, Qureshi Muhammad M, Strambo Davide, Michel Patrik, Räty Silja, Abdalkader Mohamad, Virtanen Pekka, Olive Gadea Marta, Ribo Marc, Psychogios Marios-Nikos, Nguyen Anh, Kuramatsu Joji B, Haupenthal David, Köhrmann Martin, Deuschl Cornelius, Kühne Escolà Jordi, Demeestere Jelle, Lemmens Robin, Yaghi Shadi, Shu Liqi, Kaiser Daniel P O, Puetz Volker, Kaesmacher Johannes, Mujanovic Adnan, Marterstock Dominique Cornelius, Engelhorn Tobias, Klein Piers, Haussen Diogo C, Mohammaden Mahmoud H, Cunha Bruno, Fragata Isabel, Romoli Michele, Hu Wei, Zhang Chao, Matsoukas Stavros, Fifi Johanna T, Sheth Sunil A, Salazar-Marioni Sergio, Marto João Pedro, Ramos João Nuno, Miszczuk Milena, Riegler Christoph, Poli Sven, Poli Khouloud, Jadhav Ashutosh P, Desai Shashvat M, Maus Volker, Kaeder Maximilian, Siddiqui Adnan H, Monteiro Andre, Peltola Erno, Masoud Hesham, Suryadareva Neil, Mokin Maxim, Thanki Shail, Alpay Kemal, Rautio Riitta, Siegler James E, Asdaghi Negar, Saini Vasu, Linfante Italo, Dabus Guilherme, Nolte Christian H, Siebert Eberhard, Möhlenbruch Markus A, Fischer Urs, Nogueira Raul G, Hanning Uta, Meyer Lukas, Ringleb Peter Arthur, Strbian Daniel, Nguyen Thanh N, Nagel Simon

机构信息

Neurology, Klinikum der Stadt Ludwigshafen gGmbH Neurologische Klinik, Ludwigshafen, Germany.

Neuroradiology, Heidelberg University Hospital Head Clinic Center, Heidelberg, Germany

出版信息

J Neurointerv Surg. 2024 Jun 5;17(5):508-517. doi: 10.1136/jnis-2024-021633.

DOI:10.1136/jnis-2024-021633

PMID:38839282

Abstract

BACKGROUND

The optimal anesthetic strategy for endovascular therapy (EVT) in acute ischemic stroke is still under debate. The aim of this study was to compare the clinical outcomes of patients with isolated posterior cerebral artery (PCA) occlusion stroke undergoing EVT by anesthesia modality with conscious sedation (non-GA) versus general anesthesia (GA).

METHODS

Patients from the Posterior CerebraL Artery Occlusion (PLATO) study were analyzed with regard to anesthetic strategy. GA was compared with non-GA using multivariable logistic regression and inverse probability of weighting treatment (IPTW) methods. The primary endpoint was the 90-day distribution of the modified Rankin Scale (mRS) score. Secondary outcomes included functional independence or return to Rankin at day 90, and successful reperfusion, defined as expanded Thrombolysis in Cerebral Infarction (eTICI) 2b to 3. Safety endpoints were symptomatic intracranial hemorrhage and mortality.

RESULTS

Among 376 patients with isolated PCA occlusion stroke treated with EVT, 183 (49%) had GA. The treatment groups were comparable, although the GA group contained more patients with severe stroke and lower posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS). On IPTW analysis, there was no difference between groups with regard to ordinal mRS shift analysis (common OR 0.89, 95% CI 0.53 to 1.51, P=0.67) or functional independence (OR 0.84, 95% CI 0.50 to 1.39, P=0.49). There were greater odds for successful reperfusion with GA (OR 1.70, 95% CI 1.17 to 2.47, P=0.01). Safety outcomes were comparable between groups.

CONCLUSION

In patients with isolated PCA occlusion undergoing EVT, patients treated with GA had higher reperfusion rates compared with non-GA. Both GA and non-GA strategies were safe and functional outcomes were similar.

摘要

背景

急性缺血性卒中血管内治疗（EVT）的最佳麻醉策略仍存在争议。本研究的目的是比较采用清醒镇静（非全身麻醉）与全身麻醉（GA）两种麻醉方式对孤立性大脑后动脉（PCA）闭塞性卒中患者进行EVT后的临床结局。

方法

对大脑后动脉闭塞（PLATO）研究中的患者进行麻醉策略分析。采用多变量逻辑回归和加权治疗逆概率（IPTW）方法对GA组和非GA组进行比较。主要终点是改良Rankin量表（mRS）评分的90天分布。次要结局包括90天时的功能独立性或恢复至Rankin量表状态，以及成功再灌注，定义为脑梗死扩展溶栓（eTICI）2b至3级。安全终点是有症状性颅内出血和死亡率。

结果

在376例接受EVT治疗的孤立性PCA闭塞性卒中患者中，183例（49%）接受了GA。治疗组具有可比性，尽管GA组中重度卒中患者更多，且后循环阿尔伯塔卒中项目早期CT评分（pc-ASPECTS）更低。在IPTW分析中，两组在序数mRS移位分析（共同比值比0.89，95%可信区间0.53至1.51，P=0.67）或功能独立性（比值比0.84，95%可信区间0.50至1.39，P=0.49）方面无差异。GA组成功再灌注的几率更高（比值比1.70，95%可信区间1.17至2.47，P=0.01）。两组的安全结局具有可比性。