Abstract 3745: General Versus Local Anesthesia In Endovascular Therapy For Acute Ischemic Stroke (ais) In Anterior Vessel Occlusions. A Case-control Study
Background and purpose Recent evidence supports the shift from general (GA) to local (LA) anesthesia in endovascular acute stroke therapy. However, the optimal modality of anesthesia during this type of procedure has not been established in controlled studies. We compared safety and efficacy on clinical and imaging outcomes between these two sedation modalities in a case-control study.
Methods Retrospective observational case-control study of patients with AIS and anterior arterial occlusions treated with endovascular therapy (EVT) according to similar protocols (direct IA, bridging IV t-PA/IA and failed or contraindicated IV t-PA) in two tertiary academic stroke centers that used two different sedation modalities as standard of care, the first under GA and the second under LA. From 298 patients consecutively registered between 2008 and 2011, a total of 206 were classified in two groups (GA, n=103; LA, n=103) matched by age and baseline NIHSS, blind to outcome variables. Outcome variables were ischemic lesion volume and symptomatic ICH at 24-36h, functional dependence (Rankin >3) and mortality at 3 months. Logistic regression and interaction analyses were used to evaluate the effect of GA/LA on outcome variables.
Results GA and LA groups were comparable regarding TOAST classification, occlusion site (for GA/LA n= 24/27 ICA or TICA; 51/50 MCA-1; 12/10 MCA-2; 16/16 tandem ICA-MCA), prior IV t-PA use (n= 54/61) and preprocedure TICI score. However, the time from onset to groin puncture (TOGP) was longer in GA patients (median hours, 5.0/3.6) who were more frequently treated following MRI mismatch criteria (n= 55/7). At 24-36 hours, median infarct volume was 25/56 cc (p=0.02) and sICH was found in 10/7 patients (p=NS). Ninety-four patients in each group had completed the 3 months follow-up. Functional dependence was found in 58/55 patients and mortality in 23/33 (p=NS). The adjusted OR of GA for poor functional outcome was 1.83 (95%CI, 0.84-3.97). There was a GA*TOGP interaction on poor outcome: in the TOGP <5 hours group (n=125) the OR of GA was 2.57 (1.02-6.47) whereas it was 0.18 (0.02-1.67) in the TOGP >5 h group (n=57).
Conclusions This case-control study shows that endovascular acute stroke therapy under GA results in comparable clinical and radiographic outcomes than under LA. However, GA seems to be associated with poor outcome in patients treated in less than 5 hours.
- © 2012 by American Heart Association, Inc.