Intra-Arterial Therapy for Acute Ischemic Stroke Under General Anesthesia versus Monitored Anesthesia Care

• DOI: 10.1159/000368216
• Publication Date: 2014-11-13T12:51:12Z
• Authors: Seby John; Umera Thebo; Joao Gomes; Maher Saqqur; Ehab Farag; Jijun Xu; Dolora Wisco; Ken Uchino; Muhammad S. Hussain
• Keywords: Stroke

<b><i>Background:</i></b> Recent studies have shown that intra-arterial recanalization therapy (IAT) for acute ischemic stroke (AIS) is associated with worse clinical outcomes when performed under general anesthesia (GA) compared to local anesthesia, or without conscious sedation. The reasons this association not been systematically studied. <b><i>Methods:</i></b> We retrospectively reviewed 190 patients who underwent IAT anterior circulation AIS from January 2008 December 2012 at our institution. Baseline demographics, vessels involved, treatment including intravenous tissue type plasminogen activator (tPA) use, use of GA vs. monitored care (MAC), location thrombus, grade, radiologic post-procedural intracerebral hemorrhage, and 30-day were collected. Relevant time points recorded. Detailed intra-procedural hemodynamics maximum/minimum heart rate, systolic blood pressure (BP), diastolic BP, mean pressors episodes hypotension Our study's as follows: in-hospital mortality, good outcome (mRS ≤2), successful hemorrhage. <b><i>Results:</i></b> Ninety-one received 99 MAC. There was no significant difference in the NIHSS score between two groups but group had a higher number ICA occlusions (31.9 18.2%, p = 0.043). start incision (23.0 ± 12.5 min 18.7 11.3 min, 0.020) (110 57.2 92.3 43.0, 0.045) longer group. significantly different groups. mRS 0-2 achieved 22.8% MAC 14.9% (p 0.293). Higher mortality seen (25.8 13.3%, 0.040). Successful (TICI 2b-3) similar (57.8 48.5%, 0.182) groups, parenchymal hematomas (26.3 10.1%, 0.003). hemodynamic variables Anesthesia an independent predictor (along age initial NIHSS), only hematomas, being protective both. <b><i>Conclusion:</i></b> study has confirmed previous findings poorer undergoing AIS. analysis did reveal any Parenchymal hematoma major driver outcomes.