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Hemodynamics during anesthesia for intra-arterial therapy of acute ischemic stroke
  1. Manoj Jagani1,
  2. Waleed Brinjikji2,
  3. Alejandro A Rabinstein3,
  4. Jeffrey J Pasternak4,
  5. David F Kallmes2,5
  1. 1Mayo Medical School, Rochester, Minnesota, USA
  2. 2Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
  4. 4Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
  5. 5Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Waleed Brinjikji, Mayo Clinic, Department of Radiology, 200 1st St SW, Rochester, MN 55902, USA; brinjikji.waleed{at}mayo.edu

Abstract

Background and purpose Many studies have suggested a relationship between the type of anesthesia provided during intra-arterial therapy for acute ischemic stroke and patient outcomes. Variability in blood pressure and hypotension have previously been identified as possible reasons for worse outcomes in acute stroke. Our aim was to investigate hemodynamic parameters and neurological outcomes of patients receiving either general anesthesia or conscious sedation for intra-arterial therapy of acute stroke.

Methods We performed a retrospective review of patients undergoing intra-arterial therapy from December 2008 to March 2015. Demographic data, baseline National Institutes of Health Stroke Scale score, preoperative physiological variables, procedural details, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate, and modified Rankin Scale scores were recorded.

Results 99 patients were included in the study, with 38 receiving general anesthesia and 61 receiving conscious sedation. Patients who received general anesthesia had a lower maximum SBP (p=0.02), minimum SBP (p<0.0001), minimum DBP (p<0.0001), and minimum MAP (p<0.0001). On multivariate analysis, general anesthesia was associated with lower minimum SBP (p=0.04), DBP (p=0.02), and MAP (p=0.007). Conscious sedation was associated with more favorable neurological outcomes (p=0.02). Patients with favorable neurological outcomes had a lower maximum variability in SBP (p=0.01) and MAP (p=0.03), as well as a higher minimum DBP (p=0.03).

Conclusions Patients with acute ischemic stroke undergoing intra-arterial therapy with general anesthesia had lower minimum SBP, DBP, and MAP, greater fluctuations in blood pressure, and less favorable outcomes. More studies are needed to examine the implications of variable and reduced blood pressures and neurological outcomes.

  • Blood Pressure
  • Stroke
  • Thrombectomy

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