Abstract W P18: General Anesthesia is Associated With Reduced Likelihood of Good Functional Outcome After Endovascular Intervention for Acute Ischemic Stroke
Background: Retrospective studies have suggested that the use of general anesthesia (GA) is associated with unfavorable outcomes in patients undergoing endovascular intervention for acute ischemic strokes. We aimed to assess this association in DEFUSE 2, a prospective cohort study of patients treated with endovascular therapy.
Methods: In the DEFUSE 2 study, MRI was performed before, within 12 hours after, and 5 days after endovascular intervention. Good functional outcome was defined as mRS 0-2 at 90 days. All patients who underwent catheter angiography were included in the present analysis. Baseline characteristics and outcomes were compared between patients managed with general anesthesia (GA) vs. conscious sedation (CS). Variables that were associated with good functional outcome in univariate analyses (α<0.1) were entered into a multivariable analysis. Variables that were significant at α<0.05 after a backward elimination procedure were retained.
Results: GA was utilized in 39/110 patients (35%) and CS in the remainder. Compared to the group managed with CS, those undergoing GA were older (70±13 vs. 63±17 years old), had higher SBP (156±29 vs. 144±21 mmHg), higher blood glucose levels (149±64 vs. 126±35 mg/dL), and higher NIHSS (median [IQR]: 18 [14-21] vs. 14 [9-19]). The GA group was more likely to have had a previous stroke or TIA (36% vs. 17%) and prior treatment with antiplatelet agents (46% vs. 26%). Rates of reperfusion were similar (49% vs. 65%, p=0.15) between patients managed with GA and CS. Patients managed with GA had a substantially lower rate of good functional outcome (21% vs. 55%, p=0.001). Age, DWI lesion volume, reperfusion status and GA were retained in the multivariable model as independent predictors of good functional outcome. The adjusted odds ratio for good functional outcome with GA was 0.21 (95% CI 0.07 - 0.66).
Conclusion: In general, GA should be avoided in patients undergoing endovascular treatment for acute ischemic stroke as it is associated with worse clinical outcomes. The mechanisms underlying this association should be investigated.
Author Disclosures: M. Mlynash: None. J.D. Fields: Consultant/Advisory Board; Modest; Covidien, Stryker Neurovascular. M. Straka: None. R. Bammer: None. S. Kemp: None. M.P. Marks: None. G.W. Albers: Ownership Interest; Modest; equity interest: iSchemaView. M.G. Lansberg: None.
- © 2014 by American Heart Association, Inc.