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Ischemic stroke
Original research
Anesthesia modality in endovascular treatment for distal medium vessel occlusion stroke: intention-to-treat propensity score-matched analysis
  1. Mahmoud H Mohammaden1,2,3,
  2. Mohamed F Doheim4,
  3. Hend Abdelhamid1,2,
  4. Stavros Matsoukas5,
  5. Braxton Riley Schuldt5,
  6. Johanna T Fifi5,
  7. Okkes Kuybu4,
  8. Bradley A Gross6,
  9. Alhamza R Al-Bayati4,
  10. Jaydevsinh Dolia1,2,
  11. Jonathan A Grossberg2,7,
  12. Marta Olive-Gadea8,
  13. Marc Rodrigo-Gisbert8,
  14. Manuel Requena8,
  15. Andre Monteiro9,
  16. Siyuan Yu10,
  17. James E Siegler10,
  18. Aaron Rodriguez-Calienes11,
  19. Milagros Galecio-Castillo11,
  20. Santiago Ortega-Gutierrez12,
  21. Gustavo M Cortez13,
  22. Ricardo A Hanel13,
  23. Amin Aghaebrahim13,
  24. Ameer E Hassan14,
  25. Thanh N Nguyen15,
  26. Mohamad Abdalkader16,
  27. Piers Klein15,
  28. Mohamed M Salem17,
  29. Jan-Karl Burkhardt17,
  30. Brian T Jankowitz17,
  31. Marco Colasurdo18,
  32. Peter Kan18,
  33. Muhammad Hafeez19,
  34. Omar Tanweer19,
  35. Sophia Peng20,
  36. Ali Alaraj20,
  37. Adnan H Siddiqui9,
  38. Raul G Nogueira4,
  39. Diogo C Haussen2,21
    1. 1Neurology, Emory University, Atlanta, Georgia, USA
    2. 2Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
    3. 3Neurology, Faculty of Medicine, South Valley University, Qena, Egypt
    4. 4Neurology, UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA
    5. 5Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
    6. 6Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    7. 7Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
    8. 8Neurology, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain
    9. 9Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
    10. 10Cooper Neurological Institute, Cooper University Health Care, Camden, New Jersey, USA
    11. 11Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
    12. 12Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
    13. 13Neurological Institute, Lyerley Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
    14. 14Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
    15. 15Neurology and Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
    16. 16Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
    17. 17Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
    18. 18Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
    19. 19Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
    20. 20Neurosurgery, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
    21. 21Neurology and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
    1. Correspondence to Dr Diogo C Haussen, Neurology and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA; diogo.haussen{at}emory.edu

    Abstract

    Background The optimal anesthesia modality during endovascular treatment (EVT) for distal medium vessel occlusion (DMVO) stroke is uncertain. We aimed to evaluate the association of the anesthesia modality with procedural and clinical outcomes following EVT for DMVO stroke.

    Methods This is a multicenter retrospective analysis of a prospectively collected database. Patients were included if they had DMVO involving the middle cerebral artery-M3/4, anterior cerebral artery-A2/3, or posterior cerebral artery-P1/P2-3, and underwent EVT. The cohort was divided into two groups, general anesthesia (GA) and non-general anesthesia (non-GA), and compared based on the intention-to-treat principle as primary analysis. We used propensity scores to balance the two groups. The primary outcome was the shift in the degree of disability as measured by the 90-day modified Rankin Scale (mRS). Secondary outcomes included successful reperfusion, as well as excellent (mRS 0–1) and good (mRS 0–2) clinical outcomes at 90 days. Safety measures included procedural complications, symptomatic intracerebral hemorrhage (sICH), and 90-day mortality.

    Results Among 366 DMVO thrombectomies, 61 matched pairs were eligible for analysis. Median age and National Institutes of Health Stroke Scale score as well as other baseline demographic and clinical characteristics were balanced between both groups. The GA group had no difference in the overall degree of disability (common OR 1.19, 95% CI 0.52 to 2.86, P=0.67) compared with the non-GA arm. Likewise, the GA group had comparable rates of successful reperfusion (OR 2.38, 95% CI 0.80 to 7.07, P=0.12), good/excellent clinical outcomes (OR 1.14, 95% CI 0.44 to 2.96, P=0.79/(OR 0.65, 95% CI 0.24 to 1.81, P=0.41), procedural complications (OR 1.00, 95% CI 0.19 to 5.16, P>0.99), sICH (OR 3.24, 95% CI 0.83 to 12.68, P=0.09), and 90-day mortality (OR 1.43, 95% CI 0.48 to 4.27, P=0.52) compared with the non-GA group.

    Conclusions In patients with DMVO, our study showed that GA and non-GA groups had similar procedural and clinical outcomes, as well as safety measures. Further larger controlled studies are warranted.

    • Thrombectomy
    • Stroke
    • Hemorrhage

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/jnis-2024-021668

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • X @Mahmoudneuro, @fahmy_doheim, @StavrosMatsouk, @AlAlBayati1, @JayDoliaMD, @JAGrossbergMD, @andremonteiromd, @JimSiegler, @AaronCalienes, @mili_galecio, @CerebrovascLab, @drnimajax, @NguyenThanhMD, @PiersKlein, @PeterKa80460001, @diogohaussen

      • Contributors MHM: study conception, design of the work, statistical analysis, interpretation of data, drafting of the manuscript. MFD: statistical analysis, interpretation of data, critical revision of manuscript. DCH: interpretation of data, critical revision of manuscript. Other co-authors: critical revision of manuscript. All authors gave final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MHM is responsible for the overall content as guarantor

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests MHM: no disclosure. DCH is a consultant for Stryker and Vesalio and holds stock options at Viz.AI. RGN reports consulting fees for advisory roles with Stryker Neurovascular, Cerenovus, Medtronic, Phenox, Anaconda, Genentech, Biogen, Prolong Pharmaceuticals, Imperative Care and stock options for advisory roles with Brainomix, Viz-AI, Corindus Vascular Robotics, Vesalio, Ceretrieve, Astrocyte and Cerebrotech. ARA is a consultant for Stryker Neurovascular. AEH: 1. Consultant/speaker: Medtronic, Microvention, Stryker, Penumbra, Cerenovus, Genentech, GE Healthcare, Scientia, Balt, Viz.ai, Insera therapeutics, Proximie, NovaSignal and Vesalio. 2. Principal investigator: COMPLETE study Penumbra, LVO SYNCHRONISE-Viz.ai. 3. Steering committee/publication committee member: SELECT, DAWN, SELECT 2, EXPEDITE II, EMBOLISE, CLEAR. 4. Proctor: Pipeline, FRED, Wingspan, and Onyx. 5. Supported by grants from: GE Healthcare. TNN: Research support from Medtronic, advisory board Brainomix, Associate Editor of Stroke. SOG: Grants-NIH-NINDS (R01NS127114-01, RO3NS126804-01), Stryker, Medtronic, Microvention, Methinks, Viz.ai. Consulting fees: Medtronic, Stryker Neurovascular. AA is consultant for Cerenovus. JB is an Advisory Board Member and consultant for Longeviti Neuro Solutions, and Consultant for Q’Apel Medical. BG is a consultant for Medtronic and Microvention. RAH is a consultant for Medtronic, Stryker, Cerenovus, Microvention, Balt, Phenox, Rapid Medical, and Q’Apel, on advisory board for MiVI, eLum, Three Rivers, Shape Medical and Corindus. Unrestricted research grant from NIH, Interline Endowment, Microvention, Stryker, CNX. Investor/stockholder for InNeuroCo, Cerebrotech, eLum, Endostream, Three Rivers Medical Inc, Scientia, RisT, BlinkTBI, and Corindus. ES reports a speakers’ agreement with Stryker. AA is on advisory board for iSchema View. JES reports consulting fees from AstraZeneca, and research support from Medtronic and Philips (all unrelated to the present work). The other authors report no conflicts.

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

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