Liang Fa, Zhang Kangda, Wu Youxuan, Wang Xinyan, Hou Xuan, Yu Yun, Wang Yunzhen, Wang Mengxing, Pan Yuesong, Huo Xiaochuan, Han Ruquan, Miao Zhongrong
Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Statistics, China National Clinical Research Center for Neurological Diseases, Beijing, China.
Stroke Vasc Neurol. 2025 Apr 29;10(2):e003320. doi: 10.1136/svn-2024-003320.
Endovascular therapy (EVT) now penetrates the once obscure realm of large infarct core volume acute ischaemic stroke (LICV-AIS). This research aimed to investigate the potential correlation between different anaesthetic approaches and post-EVT outcomes in LICV-AIS patients.
Between October 2020 and May 2022, the China ANGEL-Alberta Stroke Programme Early CT Score (ASPECT) trial studied patients with LICV-AIS, randomly assigning them to the best medical management (BMM) or BMM with EVT. This post hoc subgroup analysis categorised subjects receiving BMM with EVT into general anaesthesia (GA) and non-GA groups based on anaesthesia type. We applied multivariable logistic regression to evaluate the relationship between anaesthesia during EVT and patient functional outcomes, as measured by the modified Rankin scale (mRS), in addition to the occurrence of complications. Further adjustment for selection bias was achieved through propensity score matching (PSM).
In total, 230 patients with LICV-AIS were enrolled (GA 84 vs Non-GA 146). No significant difference was observed between the two groups in terms of the proportion of patients who achieved an mRS score of 0-2 at 90 days (27.4% for the GA group vs 31.5% for the non-GA group, p=0.51). However, the GA group had significantly longer median surgical times (142 min vs 122 min, p=0.03). Furthermore, GA was associated with an increased risk of postoperative pneumonia (adjusted OR 2.03, 95% CI 1.04 to 3.98). The results of PSM analysis agreed with the results of the multivariate regression analysis. No significant difference in intracranial haemorrhage incidence or mortality rate was observed between the groups.
This post hoc analysis of subgroups of the ANGEL-ASPECT trial suggested that there may be no significant association between the choice of anaesthesia and neurological outcomes in LICV-AIS patients. However, compared with non-GA, GA prolongs the duration of EVT and is associated with a greater postoperative pneumonia risk.
NCT04551664.
血管内治疗（EVT）如今已进入一度晦涩难懂的大面积梗死核心体积急性缺血性卒中（LICV - AIS）领域。本研究旨在调查LICV - AIS患者不同麻醉方式与EVT术后结局之间的潜在相关性。
在2020年10月至2022年5月期间，中国ANGEL - 阿尔伯塔卒中项目早期CT评分（ASPECT）试验对LICV - AIS患者进行了研究，将他们随机分配至最佳药物治疗（BMM）组或接受BMM联合EVT组。这项事后亚组分析根据麻醉类型将接受BMM联合EVT的受试者分为全身麻醉（GA）组和非GA组。我们应用多变量逻辑回归来评估EVT期间的麻醉与患者功能结局之间的关系，功能结局通过改良Rankin量表（mRS）衡量，同时评估并发症的发生情况。通过倾向评分匹配（PSM）进一步调整选择偏倚。
总共纳入了230例LICV - AIS患者（GA组84例，非GA组146例）。两组在90天时mRS评分为0 - 2的患者比例方面未观察到显著差异（GA组为27.4%，非GA组为31.5%，p = 0.51）。然而，GA组的中位手术时间显著更长（142分钟对122分钟，p = 0.03）。此外，GA与术后肺炎风险增加相关（调整后的OR为2.03，95%CI为1.04至3.98）。PSM分析结果与多变量回归分析结果一致。两组之间在颅内出血发生率或死亡率方面未观察到显著差异。
ANGEL - ASPECT试验亚组的这项事后分析表明，LICV - AIS患者的麻醉选择与神经学结局之间可能无显著关联。然而，与非GA相比，GA会延长EVT持续时间，并与更高的术后肺炎风险相关。
NCT04551664。
