Levee Viva, Valente Mariarosaria, Bax Francesco, Zhang Liqun, Sacco Simona, Foschi Matteo, Ornello Raffaele, Chulack Katherine, Marchong Emma, Sheikh Fahad, Fayez Feras, Del Regno Caterina, Aggour Mohammed, Sponza Massimo, Toraldo Francesco, Algazlan Razan, Lobotesis Kyriakos, Bagatto Daniele, Mansoor Nina, Kalladka Dheeraj, Gavrilovic Vladimir, Deana Cristian, Bassi Flavio, Stewart Berry, Gigli Gian Luigi, Banerjee Soma, Merlino Giovanni, D'Anna Lucio
Department of Stroke and Neuroscience, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
Stroke Unit, Udine University Hospital, Udine, Italy.
Eur Stroke J. 2024 Oct 30:23969873241293009. doi: 10.1177/23969873241293009.
There is a lack of evidence for the optimal type of anesthesia technique in patients ⩾ 90 years with acute ischemic stroke undergoing mechanical thrombectomy (MT) as this subgroup of patients was often excluded or under-represented in previous trials. We aimed to compare outcomes between general anesthesia (GA) and non-GA techniques in patients ⩾ 90 years with large vessel occlusion (LVO) undergoing MT.
Our study included patients ⩾ 90 years with anterior circulation LVO, NIHSS ⩾ 6, ASPECTS ⩾ 5 consecutively treated with MT within 6 h after stroke onset in three thrombectomy capable centers between January 1st, 2016 and March 30th, 2023. Inverse probability weighting (IPW) was used to reduce bias by indication of the anesthesia type on study outcomes. We used a weighted ordinal robust logistic regression analysis to explore the primary outcome of modified Rankin Scale (mRS) shift at 90 days in GA versus non-GA treated patients. Secondary outcomes included 90-day mortality, symptomatic intracranial hemorrhage (sICH) and TICI score of 2b, 2c, or 3.
We included 139 patients ⩾ 90 years treated with MT, 62 were in GA group and 77 in non-GA group. There was a significant shift for worse mRS scores at 90-day in non-GA treated patients (cOR 3.65, 95% CI 1.77-7.77, = 0.001). The weighted logistic regression showed that non-GA technique was an independent predictor of 90-day mortality (OR 7.49, 95% CI 2.00-28.09; = 0.003).
Our study indicated that nonagenarians with acute ischemic stroke treated with MT without GA have a worse prognosis than their counterparts undergoing MT with GA. Further studies in larger cohorts are warranted to evaluate the optimal type of anesthesia in this patient population.
对于年龄≥90岁的急性缺血性卒中患者在接受机械取栓术（MT）时，最佳麻醉技术类型缺乏证据，因为这一亚组患者在以往试验中常被排除或代表性不足。我们旨在比较年龄≥90岁的大血管闭塞（LVO）患者在接受MT时全身麻醉（GA）和非GA技术的疗效。
我们的研究纳入了年龄≥90岁、前循环LVO、美国国立卫生研究院卒中量表（NIHSS）评分≥6、脑梗死溶栓分级（ASPECTS）评分≥5的患者，这些患者于2016年1月1日至2023年3月30日期间在三个具备取栓能力的中心于卒中发作后6小时内连续接受MT治疗。采用逆概率加权（IPW）来减少麻醉类型对研究结果的指示性偏倚。我们使用加权有序稳健逻辑回归分析来探讨GA组和非GA组治疗患者在90天时改良Rankin量表（mRS）变化这一主要结局。次要结局包括90天死亡率、症状性颅内出血（sICH）以及2b、2c或3级的脑梗死溶栓（TICI）评分。
我们纳入了139例年龄≥90岁接受MT治疗的患者，GA组62例，非GA组77例。非GA组治疗患者在90天时mRS评分有显著向更差方向的变化（校正比值比3.65，95%可信区间1.77 - 7.77，P = 0.001）。加权逻辑回归显示非GA技术是90天死亡率的独立预测因素（比值比7.49，95%可信区间2.00 - 28.09；P = 0.003）。
我们的研究表明，年龄≥90岁的急性缺血性卒中患者接受MT但未行GA治疗的预后比接受MT并采用GA治疗的患者更差。有必要在更大队列中进行进一步研究，以评估该患者群体的最佳麻醉类型。
