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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, Vol. 16, No. 3, 12.02.2024, p. 230-236.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Meyer, L, Stracke, CP, Broocks, G, Wallocha, M, Elsharkawy, M, Sporns, PB, Piechowiak, EI, Kaesmacher, J, Maegerlein, C, Hernandez Petzsche, MR, Zimmermann, H, Naziri, W, Abdullayev, N, Kabbasch, C, Behme, D, Thormann, M, Maus, V, Fischer, S, Möhlenbruch, MA, Weyland, CS, Langner, S, Ernst, M, Jamous, A, Meila, D, Miszczuk, M, Siebert, E, Lowens, S, Krause, LU, Yeo, LL, Tan, BYQ, Gopinathan, A, Gory, B, Galvan Fernandez, J, Schüller Arteaga, M, Navia, P, Raz, E, Shapiro, M, Arnberg, F, Zeleňák, K, Martínez-Galdámez, M, Alexandrou, M, Kastrup, A, Papanagiotou, P, Dorn, F, Kemmling, A, Psychogios, M-N, Andersson, T, Chapot, R, Fiehler, J, Hanning, U & TOPMOST Study Group 2024, 'Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery', J NEUROINTERV SURG, vol. 16, no. 3, pp. 230-236. https://doi.org/10.1136/jnis-2023-020210

APA

Meyer, L., Stracke, C. P., Broocks, G., Wallocha, M., Elsharkawy, M., Sporns, P. B., Piechowiak, E. I., Kaesmacher, J., Maegerlein, C., Hernandez Petzsche, M. R., Zimmermann, H., Naziri, W., Abdullayev, N., Kabbasch, C., Behme, D., Thormann, M., Maus, V., Fischer, S., Möhlenbruch, M. A., ... TOPMOST Study Group (2024). Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery. J NEUROINTERV SURG, 16(3), 230-236. https://doi.org/10.1136/jnis-2023-020210

Vancouver

Meyer L, Stracke CP, Broocks G, Wallocha M, Elsharkawy M, Sporns PB et al. Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery. J NEUROINTERV SURG. 2024 Feb 12;16(3):230-236. https://doi.org/10.1136/jnis-2023-020210

Bibtex

@article{19fcabc2294f434994a95fc06f133fd3,
title = "Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery",
abstract = "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.",
author = "Lukas Meyer and Stracke, {Christian Paul} and Gabriel Broocks and Marta Wallocha and Mohamed Elsharkawy and Sporns, {Peter B} and Piechowiak, {Eike I} and Johannes Kaesmacher and Christian Maegerlein and {Hernandez Petzsche}, {Moritz Roman} and Hanna Zimmermann and Weis Naziri and Nuran Abdullayev and Christoph Kabbasch and Daniel Behme and Maximilian Thormann and Volker Maus and Sebastian Fischer and M{\"o}hlenbruch, {Markus A} and Weyland, {Charlotte Sabine} and Soenke Langner and Marielle Ernst and Ala Jamous and Dan Meila and Milena Miszczuk and Eberhard Siebert and Stephan Lowens and Krause, {Lars Udo} and Yeo, {Leonard Ll} and Tan, {Benjamin Y Q} and Anil Gopinathan and Benjamin Gory and {Galvan Fernandez}, Jorge and {Sch{\"u}ller Arteaga}, Miguel and Pedro Navia and Eytan Raz and Maksim Shapiro and Fabian Arnberg and Kamil Zele{\v n}{\'a}k and Mario Mart{\'i}nez-Gald{\'a}mez and Maria Alexandrou and Andreas Kastrup and Panagiotis Papanagiotou and Franziska Dorn and Andr{\'e} Kemmling and Marios-Nikos Psychogios and Tommy Andersson and Ren{\'e} Chapot and Jens Fiehler and Uta Hanning and {TOPMOST Study Group}",
note = "{\textcopyright} Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2024",
month = feb,
day = "12",
doi = "10.1136/jnis-2023-020210",
language = "English",
volume = "16",
pages = "230--236",
journal = "J NEUROINTERV SURG",
issn = "1759-8478",
publisher = "BMJ PUBLISHING GROUP",
number = "3",

}

RIS

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 -