Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery
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Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery. / 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; TOPMOST Study Group.
in: J NEUROINTERV SURG, Jahrgang 16, Nr. 3, 12.02.2024, S. 230-236.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery
AU - Meyer, Lukas
AU - Stracke, Christian Paul
AU - Broocks, Gabriel
AU - Wallocha, Marta
AU - Elsharkawy, Mohamed
AU - Sporns, Peter B
AU - Piechowiak, Eike I
AU - Kaesmacher, Johannes
AU - Maegerlein, Christian
AU - Hernandez Petzsche, Moritz Roman
AU - Zimmermann, Hanna
AU - Naziri, Weis
AU - Abdullayev, Nuran
AU - Kabbasch, Christoph
AU - Behme, Daniel
AU - Thormann, Maximilian
AU - Maus, Volker
AU - Fischer, Sebastian
AU - Möhlenbruch, Markus A
AU - Weyland, Charlotte Sabine
AU - Langner, Soenke
AU - Ernst, Marielle
AU - Jamous, Ala
AU - Meila, Dan
AU - Miszczuk, Milena
AU - Siebert, Eberhard
AU - Lowens, Stephan
AU - Krause, Lars Udo
AU - Yeo, Leonard Ll
AU - Tan, Benjamin Y Q
AU - Gopinathan, Anil
AU - Gory, Benjamin
AU - Galvan Fernandez, Jorge
AU - Schüller Arteaga, Miguel
AU - Navia, Pedro
AU - Raz, Eytan
AU - Shapiro, Maksim
AU - Arnberg, Fabian
AU - Zeleňák, Kamil
AU - Martínez-Galdámez, Mario
AU - Alexandrou, Maria
AU - Kastrup, Andreas
AU - Papanagiotou, Panagiotis
AU - Dorn, Franziska
AU - Kemmling, André
AU - Psychogios, Marios-Nikos
AU - Andersson, Tommy
AU - Chapot, René
AU - Fiehler, Jens
AU - Hanning, Uta
AU - TOPMOST Study Group
N1 - © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2024/2/12
Y1 - 2024/2/12
N2 - BACKGROUND: Numerous questions regarding procedural details of distal stroke thrombectomy remain unanswered. This study assesses the effect of anesthetic strategies on procedural, clinical and safety outcomes following thrombectomy for distal medium vessel occlusions (DMVOs).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.
AB - BACKGROUND: Numerous questions regarding procedural details of distal stroke thrombectomy remain unanswered. This study assesses the effect of anesthetic strategies on procedural, clinical and safety outcomes following thrombectomy for distal medium vessel occlusions (DMVOs).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.
U2 - 10.1136/jnis-2023-020210
DO - 10.1136/jnis-2023-020210
M3 - SCORING: Journal article
C2 - 37142393
VL - 16
SP - 230
EP - 236
JO - J NEUROINTERV SURG
JF - J NEUROINTERV SURG
SN - 1759-8478
IS - 3
ER -