Background and purpose Lidocaine is demonstrated as neuroprotective in animal models against hypoxia and cerebral ischemia that may reduce infarct size. The human data, however is limited. We sought to assess the potential effects of lidocaine as a preferred pretreatment agent in general anesthesia during endovascular thrombectomy (EVT) on final infarct volume (FIV) and clinical outcome in acute ischemic stroke (AIS) patients.
Methods In a single center retrospective cohort patients who underwent EVT from January 2015 to February 2017 were included. Patients were divided into general anesthesia (GA) vs conscious sedation (CS) groups, and based on agent, lidocaine vs other agent group. Baseline characteristics, imaging variables were described, final infarct volume (FIV) on MRI was calculated using osirix software at 24 hours. Primary outcome was discharge mRS (0–2). Secondary outcome was FIV at 24 hours. We compared the outcomes between GA and CS, and Lidocaine versus other agents. Logistic regression was used to compare the primary and secondary outcomes between the groups.
Results 179 patients were included. Median age 61 (IQR 26–89), median initial NIHSS 19 (IQR 5–35), mean ASPECTS 7 (4–10). Posterior circulation AIS were 10%. EVT was performed within 6 hours of symptoms onset. 79.8% received GA and 20.2% received CS. Lidocaine was used as a pretreatment agent during intubation in 84 (58.7%) patients. FIV was lower in CS group (mean 33.98 cm3 SD 43.10) p 0.02, however this was not significant after adjusting for variables including age, baseline NIHSS, collateral score and time from door to groin puncture (GP), and time from last known well (LKW) to recanalization. There was no difference in FIV between GA vs CS group (p 0.15). FIV was lower in lidocaine group (mean 61.40 cm3 SD 79.42 cm3 ) versus other agents (mean 84.4 cm3 SD 92.73 cm3) but this was not statistically significant. Higher NIHSS and poor collateral score were independently correlated with large infarct volume and clinical outcome (p 0.01, p 0.01). The overall good outcome was higher in CS group (30%) versus GA group (22%) p 0.090. Using logistic regression, there was no significant difference found between GA vs CS group in good outcome mRS (0–2) at discharge (OR 0.49; CI 0.19–1.3, p 0.15). Finally, in lidocaine group, we found that lidocaine was associated with good outcome mRS (0–2) at discharge (p 0.03) when compared to other agents. After adjusting for above variables, this was found not to be significant (OR 0.50; CI 0.19–1.2, p 0.17).
Conclusion Our results limited by small sample size, it showed potential effect of lidocaine in reducing final infarct volume, which could help improve clinical outcomes.
Disclosures J. Soomro: None. S. Reddy: None. L. Zhu: None. A. Sarraj: None.
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