Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Meyer Lukas, Stracke Christian Paul, Broocks Gabriel, Wallocha Marta, Elsharkawy Mohamed, Sporns Peter B, Piechowiak Eike I, Kaesmacher Johannes, Maegerlein Christian, Hernandez Petzsche Moritz Roman, Zimmermann Hanna, Naziri Weis, Abdullayev Nuran, Kabbasch Christoph, Behme Daniel, Thormann Maximilian, Maus Volker, Fischer Sebastian, Möhlenbruch Markus A, Weyland Charlotte Sabine, Langner Soenke, Ernst Marielle, Jamous Ala, Meila Dan, Miszczuk Milena, Siebert Eberhard, Lowens Stephan, Krause Lars Udo, Yeo Leonard Ll, Tan Benjamin Y Q, Gopinathan Anil, Gory Benjamin, Galvan Fernandez Jorge, Schüller Arteaga Miguel, Navia Pedro, Raz Eytan, Shapiro Maksim, Arnberg Fabian, Zeleňák Kamil, Martínez-Galdámez Mario, Alexandrou Maria, Kastrup Andreas, Papanagiotou Panagiotis, Dorn Franziska, Kemmling André, Psychogios Marios-Nikos, Andersson Tommy, Chapot René, Fiehler Jens, Hanning Uta, From the TOPMOST Study Group
Аннотация
METHODS: Patients with isolated DMVO stroke from the TOPMOST registry were analyzed with regard to anesthetic strategies (ie, conscious sedation (CS), local (LA) or general anesthesia (GA)). Occlusions were in the P2/P3 or A2-A4 segments of the posterior and anterior cerebral arteries (PCA and ACA), respectively. The primary endpoint was the rate of complete reperfusion (modified Thrombolysis in Cerebral Infarction score 3) and the secondary endpoint was the rate of modified Rankin Scale score 0-1. Safety endpoints were the occurrence of symptomatic intracranial hemorrhage and mortality.
RESULTS: Overall, 233 patients were included. The median age was 75 years (range 64-82), 50.6% (n=118) were female, and the baseline National Institutes of Health Stroke Scale score was 8 (IQR 4-12). DMVOs were in the PCA in 59.7% (n=139) and in the ACA in 40.3% (n=94). Thrombectomy was performed under LA±CS (51.1%, n=119) and GA (48.9%, n=114). Complete reperfusion was reached in 73.9% (n=88) and 71.9% (n=82) in the LA±CS and GA groups, respectively (P=0.729). In subgroup analysis, thrombectomy for ACA DMVO favored GA over LA±CS (aOR 3.07, 95% CI 1.24 to 7.57, P=0.015). Rates of secondary and safety outcomes were similar in the LA±CS and GA groups.
CONCLUSION: LA±CS compared with GA resulted in similar reperfusion rates after thrombectomy for DMVO stroke of the ACA and PCA. GA may facilitate achieving complete reperfusion in DMVO stroke of the ACA. Safety and functional long-term outcomes were comparable in both groups.