Romanelli Antonio, Iovino Aniello, Langone Antonella, Napoletano Rosa, Frauenfelder Giulia, Minichino Flora, D'Ambrosio Liliana, Caterino Miriam, Tortora Raffaele, Gammaldi Renato, Barone Paolo, Saponiero Renato, Romano Daniele Giuseppe
Department of Anesthesia and Intensive Care, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
Department of Neurology and Stroke, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
Acute Crit Care. 2025 May;40(2):252-263. doi: 10.4266/acc.003000. Epub 2025 Apr 11.
Endovascular mechanical thrombectomy (EMT) can be performed with general anesthesia (GA) or using non-GA techniques. Several meta-analyses on the topic have reported discordant main outcomes. The aim of this retrospective single-center study was to analyze the relationship between clinical outcomes and anesthesiological management (GA vs. non-GA) in patients who underwent EMT for acute anterior ischemic stroke (AIS).
We performed a propensity score-matched (PSM) analysis of patients who underwent EMT for acute AIS from January 2018 to December 2021. For PSM, we chose covariates influencing clinical decisions about anesthesiological management. Comparisons between groups were performed with the chi-square test for categorical variables and Student t-test or the Mann-Whitney U-test for continuous variables as appropriate. The relationships between anesthesiological management and clinical outcomes were analyzed using logistic regression, and results are reported as odds ratios with 95% confidence intervals. A two-sided P-value <0.05 was considered statistically significant.
From 194 observations (78 in the GA group, 116 in the non-GA group), after PSM, we obtained 70 data pairs. Both anesthesiological approaches resulted in similar rates of in-hospital mortality, 90-day functional independence, full recanalization, procedural complications, and intracerebral hemorrhage (ICH). Performing EMT with GA was unrelated to the in-hospital and 90-day death rates, 90-day functional independence, full recanalization rate, procedural complications, and ICH (P>0.05).
Anesthesiological management did not influence clinical outcomes of EMT for acute AIS. Physiological stability during EMT may impact outcomes more significantly than anesthesiological management. Further studies on this topic are needed.
血管内机械取栓术（EMT）可在全身麻醉（GA）下进行，也可采用非全身麻醉技术。关于该主题的多项荟萃分析报告的主要结果不一致。这项回顾性单中心研究的目的是分析急性前循环缺血性卒中（AIS）患者接受EMT时临床结局与麻醉管理（全身麻醉与非全身麻醉）之间的关系。
我们对2018年1月至2021年12月因急性AIS接受EMT的患者进行了倾向评分匹配（PSM）分析。对于PSM，我们选择了影响麻醉管理临床决策的协变量。分类变量采用卡方检验，连续变量根据情况采用Student t检验或Mann-Whitney U检验进行组间比较。使用逻辑回归分析麻醉管理与临床结局之间的关系，结果以比值比及95%置信区间表示。双侧P值<0.05被认为具有统计学意义。
从194例观察对象（全身麻醉组78例，非全身麻醉组116例）中，经过PSM后，我们获得了70对数据。两种麻醉方法导致的院内死亡率、90天功能独立性、完全再通、手术并发症和脑出血（ICH）发生率相似。采用全身麻醉进行EMT与院内和90天死亡率、90天功能独立性、完全再通率、手术并发症和ICH均无关（P>0.05）。
麻醉管理不影响急性AIS患者EMT的临床结局。EMT期间的生理稳定性可能比麻醉管理对结局的影响更大。需要对此主题进行进一步研究。
