Onalan Aysenur, Gurkas Erdem, Akpinar Cetin Kursad, Aykaç Özlem, Acar Turkan, Acar Bilgehan, Kocabaş Zehra Uysal, Doğan Hasan, Balgetir Ferhat, Genc Sule Kavak, Yabalak Ahmet, Ozdemir Atilla Ozcan
Stroke Center, Istanbul Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Türkiye.
Stroke Center, Samsun Training and Research Hospital, Samsun, Türkiye.
Front Neurol. 2024 Aug 1;15:1416146. doi: 10.3389/fneur.2024.1416146. eCollection 2024.
Ischemic cerebrovascular disease (ICVD) is a serious health problem in which brain tissue suffers from hypoxic damage due to obstruction in cerebral vessels. Mechanical thrombectomy is a commonly used method in the treatment of these patients. However, the effects of local anesthesia (LA) and conscious sedation (CS) during thrombectomy are still unclear. We evaluated whether there was a relationship between the two anesthesia regimens in terms of 90-day modified Rankin Scale (mRS) scores.
In this study, a retrospective observational study was conducted to evaluate the effects of LA and CS used during mechanical thrombectomy in four comprehensive stroke centers among ICVD patients. Patients were divided into the LA group and the CS group. Statistical analysis was performed before and after 1:1 matching under propensity score matching (PSM) analysis. The primary outcome measure was an mRS score of 0-2 at 90 days. Secondary outcomes were procedure times, recanalization rates, symptomatic and asymptomatic hemorrhage rates, and procedural complications.
A total of 193 patients (118 patients with LA and 75 patients with CS) were included in the final analysis before PSM. After 1:1 PSM, 98 patients-49 patients from each group-were included in the study. There was no difference in clinical outcomes between the LA- and CS-applied groups ( = 0.543). When blood pressure (BP) values at follow-up after endovascular treatment (EVT) were compared, the lowest systolic and lowest diastolic BP were found to be lower in the CS group ( = 0.001 and = 0.009). There was no significant difference between the two groups in terms of recanalization rates, symptomatic intracranial hemorrhage (sICH) rates, 90-day mRS, and procedure-related complication rates ( = 0.617, = 0.274, = 0.543, and = 1.000).
This study did not reveal the superiority of CS applied during EVT on 90-day mRS, sICH, recanalization rates, or procedural complications. However, the risk of developing hypotension during the CS application was found to be high.
缺血性脑血管疾病（ICVD）是一个严重的健康问题，其中脑组织因脑血管阻塞而遭受缺氧损伤。机械取栓术是治疗这些患者的常用方法。然而，取栓术中局部麻醉（LA）和清醒镇静（CS）的效果仍不明确。我们评估了两种麻醉方案在90天改良Rankin量表（mRS）评分方面是否存在关联。
在本研究中，进行了一项回顾性观察研究，以评估ICVD患者在四个综合卒中中心进行机械取栓术时使用LA和CS的效果。患者分为LA组和CS组。在倾向得分匹配（PSM）分析下进行1:1匹配前后进行统计分析。主要结局指标是90天时的mRS评分为0 - 2。次要结局包括手术时间、再通率、有症状和无症状出血率以及手术并发症。
在PSM之前的最终分析中，共纳入193例患者（118例接受LA，75例接受CS）。经过1:1 PSM后，研究纳入了98例患者，每组各49例。应用LA组和CS组的临床结局无差异（=0.543）。比较血管内治疗（EVT）后随访时的血压（BP）值，发现CS组的最低收缩压和最低舒张压较低（=0.001和=0.009）。两组在再通率、有症状颅内出血（sICH）率、90天mRS和手术相关并发症率方面无显著差异（=0.617，=0.274，=0.543，=1.000）。
本研究未揭示EVT期间应用CS在90天mRS、sICH、再通率或手术并发症方面的优越性。然而，发现应用CS期间发生低血压的风险较高。
