Abstract WP15: Dexmedetomidine versus Propofol for Monitored Anesthesia Care (MAC) during Endovascular Therapy for Acute Ischemic Stroke
INTRODUCTION: Previous studies have reported that compared to MAC, general anesthesia during intra-arterial therapy (IAT) for acute stroke is associated with worse outcomes. Propofol (PROP) and dexmedetomidine (DXM) are commonly used agents for MAC. While PROP can be associated with significant hemodynamic changes, DXM has been linked to cerebral vasoconstriction and transient decreases in brain oxygenation. We studied if there was a difference in outcomes in patients who underwent IAT for acute anterior circulation ischemic stroke (AAIS) under PROP or DXM MAC.
Methods A prospectively maintained neuroendovascular database identified all patients who underwent IAT for AAIS under MAC from January 2010 to December 2011. Patient demographics, stroke characteristics, baseline NIHSS and mRS scores, pre and post-treatment stroke volumes on diffusion-weighted imaging (DWI), intra-procedural hemodynamics, discharge/30-day outcomes and mortality were collected. Descriptive statistics, one-way ANOVA and uni/multi-variate analysis were performed.
Results The study included 52 patients, 30 treated with DXM and 22 with PROP. There were no significant differences in demographics, baseline mRS and NIHSS scores. Occlusion of the ICA terminus was more common in the PROP group and M1 segment occlusions in DXM. Revascularization was achieved in 86% of patients in the DXM group compared to 81% in PROP. Mean maximum Mean Arterial Pressure (MAP) was 133 and 139 mm Hg in DXM and PROP groups respectively. There were more hypotensive episodes in the DXM group and use of pressors was also significantly higher (80% vs 20%). There were no significant differences in DWI infarct growth (mean volume DXM 56cc, PROP 62cc). Functional outcomes and mortality were similar (30% mortality in DXM, 32% in PROP).
Conclusion This is the first study comparing outcomes after IAT under MAC for AAIS using different agents. Although counterintuitive, our data suggests that DXM was associated with more hemodynamic changes than PROP. No differences in clinical or radiographic outcomes were found. This finding along with known cerebral vascoconstrictive effects of DXM should prompt cautious use of DXM in IAT. Larger prospective studies are warranted to confirm our observation.
- © 2012 by American Heart Association, Inc.