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Updated: Jun 3, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
AMETIS Preplanned Ancillary Study: Impact of Agitation During Mechanical Thrombectomy Under Sedation
Caroline Tabillon1, Rémy Bernard1, Alice Jacquens1
1Anesthésie et Neuro-Réanimation chirurgicale Babinski, Département d'Anesthésie-Réanimation, Assistance Publique Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, France (C.T., R.B., A.J., V.D.).
Background:
Mechanical thrombectomy is the treatment of choice for ischemic strokes of the anterior circulation with proximal occlusion. Mechanical thrombectomy can be performed under sedation, which can lead to episodes of periprocedural agitation. The aim of this study is to describe the prevalence of agitation and determine the consequences during and after mechanical thrombectomy.
Methods:
This is an ancillary study to the AMETIS study (Anesthesia Management in Endovascular Therapy for Ischemic Stroke). We evaluated the patients from the sedation group of this randomized trial; some patients presented at least 1 episode of agitation during the procedure (determined by a Richmond Agitation-Sedation Scale score >1) prospectively collected. We explored the association between agitation and a composite outcome (Thrombolysis in Cerebral Infarction score <2b and/or arterial perforation) through univariate and multivariate analyses, accounting for confounders (agitation, age, National Institutes of Health Stroke Scale score, local thrombus) identified a priori by the acyclic diagram method.
Results:
Among the 138 participants (average age, 71±14 years; 72 [52%] male; average National Institutes of Health Stroke Scale score, 15±6), 53 (38%) experienced at least 1 agitation episode. Agitation was neither a risk factor of Thrombolysis in Cerebral Infarction score <2b and/or arterial perforation in univariate and multivariate analyses (adjusted odds ratio, 1.29 [0.57-2.92]; P=0.5), nor a risk of unfavorable outcome (adjusted OR, 0.7 [0.18-2.56]; P=0.56). Although, agitated patients had a higher incidence of conversion with intubation (21% versus 5%; OR, 5.3 [1.7-20]; P<0.01) and significantly worse radiological image quality (62% versus 17%; OR, 8.37 [3.9-19.1]; P<0.01).
Conclusions:
Our study found a high frequency of agitation during mechanical thrombectomy under sedation. Despite the absence of any significant link with prognosis, Thrombolysis in Cerebral Infarction score, and perforations, there is more conversion to general anesthesia with intubation and poorer quality images.
Insights
Agitation during mechanical thrombectomy for ischemic stroke is common but does not impact outcomes. However, agitation increases the need for intubation and reduces image quality.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Anesthesiology
Background:
- Mechanical thrombectomy is the standard treatment for anterior circulation ischemic strokes.
- Sedation during mechanical thrombectomy can lead to patient agitation.
- Understanding agitation's prevalence and consequences is crucial for procedural management.
Purpose of the Study:
- To determine the frequency of agitation during mechanical thrombectomy.
- To investigate the association between agitation and procedural complications.
- To assess the impact of agitation on clinical and radiological outcomes.
Main Methods:
- Ancillary study to the AMETIS trial, focusing on the sedation group.
- Prospective collection of agitation episodes using the Richmond Agitation-Sedation Scale.
- Univariate and multivariate analyses to assess agitation's association with outcomes, controlling for confounders.
Main Results:
- 38% of patients experienced agitation during mechanical thrombectomy.
- Agitation was not significantly associated with poor Thrombolysis in Cerebral Infarction scores or arterial perforations.
- Agitated patients had a higher rate of conversion to general anesthesia with intubation (21% vs. 5%) and poorer radiological image quality (62% vs. 17%).
Conclusions:
- Agitation is frequent during mechanical thrombectomy under sedation.
- Agitation does not appear to worsen stroke outcomes or procedural success (TICI score, perforations).
- Agitation is linked to increased intubation rates and compromised image quality, necessitating careful sedation management.
