Article Text
Abstract
Background The “General or Local Anesthesia in Intra-Arterial Therapy” (GOLIATH) trial compared infarct growth and outcome in patients undergoing endovascular therapy (EVT) under either general anesthesia (GA) or conscious sedation (CS). The results were the same for the primary outcome (infarct growth) but successful reperfusion was higher in the GA arm.
Objective To further examine differences in the quality and safety of EVT with the two anesthetic regimens in a post hoc analysis of GOLIATH.
Methods In GOLIATH, 128 subjects with anterior circulation large vessel occlusion stroke within 6 hours of onset were randomized to either GA or CS (1:1 allocation). We compared the quality of reperfusion, treatment delay, use of catheters, and contrast and radiation dosage between the trial arms.
Results Sixty-five subjects were randomized to GA. Baseline demographic and clinical variables were similar between the treatment arms. We found no difference in procedure time, contrast dose, or radiation dose between the two arms. Tandem occlusions were associated with a longer procedure time, but there was no difference between the two arms. There was no difference in reperfusion rates between the direct aspiration technique and a stent retriever (86% vs 79%, respectively, p=0.54), but aspiration was associated with a shorter procedure time (28 min vs 42 min for a stent retriever), p=0.03.
Conclusion Safety and quality of EVT under either GA and CS are comparable.
Trial registration Unique identifier: NCT02317237;Post-results.
- MRI
- stroke
- thrombectomy
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Footnotes
Contributors LS and MR: study concept andcollected data. LOS and SK: collected data. AJY: imaging analysis. KES: dataanalysis. CZS: study concept, drafting manuscript, statistics. Editingmanuscript: all.
Funding This work was supported by Aarhus University Hospital.
Competing interests AJY report research grants from Penumbra Inc. and Neuravi Inc. MR is supported by a research grant from Health Research Fund of Central Denmark Region. CZS is supported by a grant from Novo Nordisk Foundation.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data are availablefrom the corresponding author upon reasonable request.
Patient consent for publication Not required.