Endovascular therapy of isolated posterior cerebral artery occlusion stroke with and without general anesthesia

Berberich A, Herweh C, Qureshi MM, Strambo D, Michel P, Räty S, Abdalkader M, Virtanen P, Olive Gadea M, Ribo M, Psychogios MN, Nguyen A, Kuramatsu J, Haupenthal D, Köhrmann M, Deuschl C, Kühne Escolà J, Demeestere J, Lemmens R, Yaghi S, Shu L, Kaiser DP, Puetz V, Kaesmacher J, Mujanovic A, Marterstock D, Engelhorn T, Klein P, Haussen DC, Mohammaden MH, Cunha B, Fragata I, Romoli M, Hu W, Zhang C, Matsoukas S, Fifi JT, Sheth SA, Salazar-Marioni S, Marto J, Ramos JN, Miszczuk M, Riegler C, Poli S, Poli K, Jadhav AP, Desai SM, Maus V, Kaeder M, Siddiqui AH, Monteiro A, Peltola E, Masoud H, Suryadareva N, Mokin M, Thanki S, Alpay K, Rautio R, Siegler JE, Asdaghi N, Saini V, Linfante I, Dabus G, Nolte CH, Siebert E, Möhlenbruch MA, Fischer U, Nogueira RG, Hanning U, Meyer L, Ringleb PA, Strbian D, Nguyen TN, Nagel S (2024)

Publication Type: Journal article

Publication year: 2024

Journal

DOI: 10.1136/jnis-2024-021633

Abstract

Background: The optimal anesthetic strategy for endovascular therapy (EVT) in acute ischemic stroke is still under debate. The aim of this study was to compare the clinical outcomes of patients with isolated posterior cerebral artery (PCA) occlusion stroke undergoing EVT by anesthesia modality with conscious sedation (non-GA) versus general anesthesia (GA). Methods: Patients from the Posterior CerebraL Artery Occlusion (PLATO) study were analyzed with regard to anesthetic strategy. GA was compared with non-GA using multivariable logistic regression and inverse probability of weighting treatment (IPTW) methods. The primary endpoint was the 90-day distribution of the modified Rankin Scale (mRS) score. Secondary outcomes included functional independence or return to Rankin at day 90, and successful reperfusion, defined as expanded Thrombolysis in Cerebral Infarction (eTICI) 2b to 3. Safety endpoints were symptomatic intracranial hemorrhage and mortality. Results: Among 376 patients with isolated PCA occlusion stroke treated with EVT, 183 (49%) had GA. The treatment groups were comparable, although the GA group contained more patients with severe stroke and lower posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS). On IPTW analysis, there was no difference between groups with regard to ordinal mRS shift analysis (common OR 0.89, 95% CI 0.53 to 1.51, P=0.67) or functional independence (OR 0.84, 95% CI 0.50 to 1.39, P=0.49). There were greater odds for successful reperfusion with GA (OR 1.70, 95% CI 1.17 to 2.47, P=0.01). Safety outcomes were comparable between groups. Conclusion: In patients with isolated PCA occlusion undergoing EVT, patients treated with GA had higher reperfusion rates compared with non-GA. Both GA and non-GA strategies were safe and functional outcomes were similar.

Authors with CRIS profile

Involved external institutions

Boston Medical Center (BMC) United States (USA) (US) Ruprecht-Karls-Universität Heidelberg Germany (DE) Helsinki University Central Hospital (HUCH) / Helsingin seudun yliopistollinen keskussairaala (HYKS) Finland (FI) Vall d'Hebron University Hospital / Hospital Universitari Vall d'Hebron Spain (ES) Universitätsspital Basel Switzerland (CH) Universitätsklinikum Essen Germany (DE) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven Belgium (BE) Klinikum der Stadt Ludwigshafen am Rhein gGmbH Germany (DE) Universitätsklinikum Heidelberg Germany (DE) Brown University United States (USA) (US) Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV) Switzerland (CH) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Emory University United States (USA) (US) Inselspital, Universitätsspital Bern Switzerland (CH) Helsingin yliopisto / University of Helsinki Finland (FI) Boston University United States (USA) (US) Centro Hospitalar de Lisboa Central Portugal (PT) University of Science and Technology of China (USTC) China (CN) Mount Sinai Hospital United States (USA) (US) Icahn School of Medicine at Mount Sinai United States (USA) (US) Ospedale “M. Bufalini” di Cesena Italy (IT) Charité - Universitätsmedizin Berlin Germany (DE) McGovern Medical School United States (USA) (US) University of Texas Health Science Center at Houston (UTHealth) United States (USA) (US) Eberhard Karls Universität Tübingen Germany (DE) Hospital de Egas Moniz Portugal (PT) Baptist Health South Florida United States (USA) (US) University of Pittsburgh United States (USA) (US) Universitätsklinikum Knappschaftskrankenhaus Bochum Germany (DE) University at Buffalo. State University of New York United States (USA) (US) University of Pittsburgh Medical Center (UPMC) United States (USA) (US) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) State University of New York Upstate Medical University (SUNY) United States (USA) (US) University of South Florida (USF) United States (USA) (US)

How to cite

APA:

Berberich, A., Herweh, C., Qureshi, M.M., Strambo, D., Michel, P., Räty, S.,... Nagel, S. (2024). Endovascular therapy of isolated posterior cerebral artery occlusion stroke with and without general anesthesia. Journal of Neurointerventional Surgery. https://doi.org/10.1136/jnis-2024-021633

MLA:

Berberich, Anne, et al. "Endovascular therapy of isolated posterior cerebral artery occlusion stroke with and without general anesthesia." Journal of Neurointerventional Surgery (2024).

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