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Association between anesthesia modality and clinical outcomes following endovascular stroke treatment in the extended time window

Dhillon, Permesh Singh; Butt, Waleed; Podlasek, Anna; McConachie, Norman; Lenthall, Robert; Nair, Sujit; Malik, Luqman; Hewson, David W.; Bhogal, Pervinder; Makalanda, Hegoda Levansri Dilrukshan; James, Martin A.; Dineen, Robert A.; England, Timothy J.

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Authors

Permesh Singh Dhillon

Waleed Butt

Anna Podlasek

Norman McConachie

Robert Lenthall

Sujit Nair

Luqman Malik

David W. Hewson

Pervinder Bhogal

Hegoda Levansri Dilrukshan Makalanda

Martin A. James

ROBERT DINEEN rob.dineen@nottingham.ac.uk
Professor of Neuroradiology



Abstract

Background: There is a paucity of data on anesthesia-related outcomes for endovascular treatment (EVT) in the extended window (>6 hours from ischemic stroke onset). We compared functional and safety outcomes between local anesthesia (LA) without sedation, conscious sedation (CS) and general anesthesia (GA).

Methods: Patients who underwent EVT in the early (<6 hours) and extended time windows using LA, CS, or GA between October 2015 and March 2020 were included from a UK national stroke registry. Multivariable analyses were performed, adjusted for age, sex, baseline stroke severity, pre-stroke disability, EVT technique, center, procedural time and IV thrombolysis.

Results: A total of 4337 patients were included, 3193 in the early window (1135 LA, 446 CS, 1612 GA) and 1144 in the extended window (357 LA, 134 CS, 653 GA). Compared with GA, patients treated under LA alone had increased odds of an improved modified Rankin Scale (mRS) score at discharge (early: adjusted common (ac) OR=1.50, 95% CI 1.29 to 1.74, p=0.001; extended: acOR=1.29, 95% CI 1.01 to 1.66, p=0.043). Similar mRS scores at discharge were found in the LA and CS cohorts in the early and extended windows (p=0.21). Compared with CS, use of GA was associated with a worse mRS score at discharge in the early window (acOR=0.73, 95% CI 0.45 to 0.96, p=0.017) but not in the extended window (p=0.55). There were no significant differences in the rates of symptomatic intracranial hemorrhage or in-hospital mortality across the anesthesia modalities in the extended window.

Conclusion: LA without sedation during EVT was associated with improved functional outcomes compared with GA, but not CS, within and beyond 6 hours from stroke onset. Prospective studies assessing anesthesia-related outcomes in the extended time window are warranted.

Citation

Dhillon, P. S., Butt, W., Podlasek, A., McConachie, N., Lenthall, R., Nair, S., …England, T. J. (2023). Association between anesthesia modality and clinical outcomes following endovascular stroke treatment in the extended time window. Journal of NeuroInterventional Surgery, 15(5), 478-482. https://doi.org/10.1136/neurintsurg-2022-018846

Journal Article Type Article
Acceptance Date Apr 8, 2022
Online Publication Date Apr 21, 2022
Publication Date 2023-05
Deposit Date Apr 20, 2022
Publicly Available Date Apr 21, 2022
Journal Journal of NeuroInterventional Surgery
Print ISSN 1759-8478
Electronic ISSN 1759-8486
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 15
Issue 5
Pages 478-482
DOI https://doi.org/10.1136/neurintsurg-2022-018846
Keywords Neurology (clinical); General Medicine; Surgery
Public URL https://nottingham-repository.worktribe.com/output/7783561
Publisher URL https://jnis.bmj.com/content/15/5/478