Abstract W P6: North American Solitaire Stent-Retriever Acute Stroke Registry: Choice of Anesthesia and Outcomes
Background and Purpose: Previous work has suggested that general anesthesia (GA) may have a negative impact on outcomes in acute ischemic stroke (AIS) patients undergoing endovascular therapy, however, those data predated the availability of the safer and possibly more effective stentriever devices.
Methods: The investigator-initiated NASA Registry recruited North American sites to submit demographic, clinical, procedural (including use of GA versus local anesthesia [LA]), and site-adjudicated angiographic and clinical outcome data on consecutive patients treated with the Solitaire™ FR device. The primary outcomes were mRS at 90-days, mortality, and sICH.
Results: A total of 281 patients from 18 centers were enrolled in this sub-study. GA was utilized in 69.8% (196/281) of patients. Baseline demographics were comparable between the LA and GA groups, except the former demonstrated a longer time to groin puncture (395.4±254 versus 337.4±208min, p=0.04) and slightly lower NIHSS (16.2±5.8 versus 18.8±6.9, p=0.002). Procedural factors were also similar, although lower balloon-guide catheter usage (22.4% versus 49.2%, p=0.0001) and longer fluoroscopy times (39.5±33 versus 28±22.8min, p=0.008) were seen in the LA versus GA cohorts, respectively. Recanalization (TICI≥2a) success (91.8 versus 86.8%, p=0.3) and the rate of sICH (7.1% versus 11.2%, p=0.4) were similar between the LA and GA patients, respectively. The primary outcome of mRS≤2 was achieved in 52.6% and 35.6% (OR 1.4[1.1-1.8], p=0.01) of LA and GA patients, respectively. In a multivariate analysis, hypertension, NIHSS, unsuccessful revascularization, and GA use (OR 3.3(1.6-7.1), p=0.001) were associated with death. To account for potential confounders, when only anterior circulation patients and patients who were electively intubated were included, there was a persistent difference in good outcomes in favor of the LA patients (50.7% versus 35.5%, OR 1.3[1.01-1.6], p=0.04).
Conclusions: The NASA Registry has demonstrated that clinical outcomes and survival are significantly better in patients treated without GA without any increase in sICH. Future AIS trials should prospectively evaluate the effect of GA on outcomes.
Author Disclosures: A. Abou-Chebl: Consultant/Advisory Board; Modest; Codman- J&J. O.O. Zaidat: None. A.C. Castonguay: None. G. Dabus: Consultant/Advisory Board; Modest; Covidien, Codman, Reverse Medical. M.T. Froehler: None. V. Janardhan: None. A. Nanda: None. T.N. Nguyen: Consultant/Advisory Board; Modest; Penumbra Inc.. C. Sun: None. R.G. Nogueria: Other Research Support; Modest; Stryker Neurovascular. Consultant/Advisory Board; Modest; Covidien, Penumbra, Rapid Medical.
- © 2014 by American Heart Association, Inc.