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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Anesthesia for Endovascular Therapy for Stroke
Arianna Gaspari1, Giulia Vaccari2, Federica Arturi2
1Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria di Modena, Via del Pozzo 71, 41125 Modena, Italy.
Insights
Anesthesia choice for acute ischemic stroke thrombectomy did not impact outcomes. General anesthesia, conscious sedation, or local anesthesia alone showed similar functional and clinical results, supporting conscious sedation protocols.
Area of Science:
- Neurology
- Anesthesiology
- Interventional Radiology
Background:
- Standard care for acute ischemic stroke involves intra-arterial endovascular thrombectomy alongside intravenous thrombolysis.
- Anesthetic techniques for this procedure vary, prompting investigation into their impact on patient outcomes.
Purpose of the Study:
- To compare clinical outcomes of endovascular thrombectomy for acute ischemic stroke under different anesthetic regimens.
- To evaluate the safety and efficacy of general anesthesia, conscious sedation, and local anesthesia in this patient population.
Main Methods:
- Patients undergoing endovascular thrombectomy were stratified into three groups: general anesthesia, conscious sedation with local anesthesia, and local anesthesia only.
- Vital parameters, procedure duration, and functional outcomes (NIHSS, MRS) were assessed at various time points.
Main Results:
- No significant differences were observed in vital parameters (e.g., MAP) or revascularization duration across the anesthetic groups.
- Functional and clinical outcomes, assessed by NIHSS and MRS scores at 7 days, discharge, and 3 months, showed no significant variations between groups.
Conclusions:
- Endovascular thrombectomy success rates and clinical outcomes are comparable across general anesthesia, conscious sedation, and local anesthesia.
- The findings support the implementation of conscious sedation protocols to standardize treatment for patients undergoing endovascular procedures.
Background:
In patients with acute ischemic stroke, the standard of care is to perform intra-arterial endovascular thrombectomy in addition to intravenous thrombolysis. In this study, we investigated the different anesthetic techniques chosen for this procedure and clinical outcomes.
Methods:
Patients undergoing endovascular procedures were divided into three groups. The first group consisted of patients who received general anesthesia, the second group underwent the procedure under conscious sedation and local anesthesia at the catheter insertion site, and lastly the third group included patients who received only local anesthesia at the catheter insertion site, without sedation.
Results:
During the endovascular procedure, we did not notice significant differences in vital parameters, in particular the mean blood pressure (MAP) between patients treated with different types of anesthesia. Also, the duration of the revascularization did not show significant differences between the three groups. The main point is the absence of differences in terms of functional and clinical outcomes, using various scores as reference, such as the National Institutes of Health Stroke Scale (NIHSS) score at 7 days, NIHSS and Modified Rankin Scale (MRS) at time of discharge, and MRS after 3 months. These scores did not show significant differences in groups treated with different types of anesthesia.
Conclusions:
The rate of success of the revascularization procedure is almost overlapping between patients treated with conscious sedation and general anesthesia. In addition, we did not notice significant differences between groups in terms of functional and clinical outcomes. Considering the possible usefulness of applying conscious sedation, at OCSAE of Baggiovara, an internal protocol for conscious sedation was introduced to standardize the treatment in patients undergoing endovascular procedures.
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