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Association between anesthesia modality and clinical outcomes following endovascular stroke treatment in the extended time window
  1. Permesh Singh Dhillon1,2,3,
  2. Waleed Butt4,
  3. Anna Podlasek5,
  4. Norman McConachie1,
  5. Robert Lenthall1,
  6. Sujit Nair1,
  7. Luqman Malik1,
  8. David W Hewson6,
  9. Pervinder Bhogal7,
  10. Hegoda Levansri Dilrukshan Makalanda7,
  11. Martin A James8,9,10,
  12. Robert A Dineen11,
  13. Timothy J England3,12
  1. 1 Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
  2. 2 NIHR Nottingham Biomedical Research Centre, Nottingham, UK
  3. 3 Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham School of Medicine, Nottingham, UK
  4. 4 Interventional Neuroradiology, University Hospitals Birmingham NHS Trust, Birmingham, UK
  5. 5 Tayside Innovation Medtech Ecosystem (TIME), University of Dundee, Dundee, UK
  6. 6 Anaesthesia and Critical Care Research Group, Academic Unit of Injury Inflammation and Recovery Sciences, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
  7. 7 Interventional Neuroradiology, Barts Health NHS Trust, London, UK
  8. 8 Exeter Medical School, University of Exeter Medical School, Exeter, UK
  9. 9 Stroke, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  10. 10 Sentinel Stroke National Audit Programme, King’s College London, London, UK
  11. 11 Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
  12. 12 Stroke, University Hospitals of Derby and Burton NHS Foundation Trust, Nottingham, UK
  1. Correspondence to Dr Permesh Singh Dhillon, Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK; permesh.dhillon{at}nhs.net

Abstract

Background There is a paucity of data on anesthesia-related outcomes for endovascular treatment (EVT) in the extended window (>6 hours from ischemic stroke onset). We compared functional and safety outcomes between local anesthesia (LA) without sedation, conscious sedation (CS) and general anesthesia (GA).

Methods Patients who underwent EVT in the early (<6 hours) and extended time windows using LA, CS, or GA between October 2015 and March 2020 were included from a UK national stroke registry. Multivariable analyses were performed, adjusted for age, sex, baseline stroke severity, pre-stroke disability, EVT technique, center, procedural time and IV thrombolysis.

Results A total of 4337 patients were included, 3193 in the early window (1135 LA, 446 CS, 1612 GA) and 1144 in the extended window (357 LA, 134 CS, 653 GA). Compared with GA, patients treated under LA alone had increased odds of an improved modified Rankin Scale (mRS) score at discharge (early: adjusted common (ac) OR=1.50, 95% CI 1.29 to 1.74, p=0.001; extended: acOR=1.29, 95% CI 1.01 to 1.66, p=0.043). Similar mRS scores at discharge were found in the LA and CS cohorts in the early and extended windows (p=0.21). Compared with CS, use of GA was associated with a worse mRS score at discharge in the early window (acOR=0.73, 95% CI 0.45 to 0.96, p=0.017) but not in the extended window (p=0.55). There were no significant differences in the rates of symptomatic intracranial hemorrhage or in-hospital mortality across the anesthesia modalities in the extended window.

Conclusion LA without sedation during EVT was associated with improved functional outcomes compared with GA, but not CS, within and beyond 6 hours from stroke onset. Prospective studies assessing anesthesia-related outcomes in the extended time window are warranted.

  • Blood Pressure
  • Intervention
  • Stroke
  • Thrombectomy

Data availability statement

Data may be obtained from a third party and are not publicly available. Data access requests should be directed to SSNAP as the data provider and HQIP as the data controller.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Data access requests should be directed to SSNAP as the data provider and HQIP as the data controller.

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Footnotes

  • Twitter @PermeshSD, @hldmak

  • Contributors Conception and design: PSD, WB. Acquisition of data: PSD. Analysis and interpretation of data: PSD, WB. Critical revision of the manuscript: PSD, WB, AP, NM, RL, SN, LM, DWH, PB, HLDM, MAJ, RAD, TJE. Study supervision: RAD, TJE. Guarantor of this work: PSD. All authors approved the final version of the manuscript.

  • Funding SSNAP is commissioned by the Health Quality Improvement Partnership and funded by National Health Service (NHS) England and the Welsh Government. MAJ is supported by the National Institute for Health Research Applied Research Collaboration South West Peninsula.

  • Competing interests MAJ receives lecture and consultancy fees from Medtronic. PB has consulting agreements with Phenox, Balt, Neurovasc Technologies, Cerenovus, Perfuze, Brainomix, and Vesalio.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.