RT Journal Article
SR Electronic
T1 Monitored anesthesia care during mechanical thrombectomy for stroke: need for data-driven and individualized decisions
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 1088
OP 1094
DO 10.1136/neurintsurg-2020-016732
VO 13
IS 12
A1 Raul G Nogueira
A1 Mahmoud H Mohammaden
A1 Timothy P Moran
A1 Matthew K Whalin
A1 Raphael Y Gershon
A1 Alhamza R R Al-Bayati
A1 Jonathan Ratcliff
A1 Leonardo Pisani
A1 Bernardo Liberato
A1 Nirav Bhatt
A1 Michael R Frankel
A1 Diogo C Haussen
YR 2021
UL http://jnis.bmj.com/content/13/12/1088.abstract
AB Background The optimal anesthesia management for patients with stroke undergoing mechanical thrombectomy (MT) during the COVID-19 pandemic has become a matter of controversy. Some recent guidelines have favored general anesthesia (GA) in patients perceived as high risk for intraprocedural conversion from sedation to GA, including those with dominant hemispheric occlusions/aphasia or baseline National Institutes of Health Stroke Scale (NIHSS) score >15. We aim to identify the rate and predictors of conversion to GA during MT in a high-volume center where monitored anesthesia care (MAC) is the default modality.Methods A retrospective review of a prospectively maintained MT database from January 2013 to July 2020 was undertaken. Analyses were conducted to identify the predictors of intraprocedural conversion to GA. In addition, we analyzed the GA conversion rates in subgroups of interest.Results Among 1919 MT patients, 1681 (87.6%) started treatment under MAC (median age 65 years (IQR 55–76); baseline NIHSS 16 (IQR 11–21); 48.4% women). Of the 1677 eligible patients, 26 (1.6%) converted to GA including 1.4% (22/1615) with anterior and 6.5% (4/62) with posterior circulation strokes. The only predictor of GA conversion was posterior circulation stroke (OR 4.99, 95% CI 1.67 to 14.96, P=0.004). The conversion rates were numerically higher in right than in left hemispheric occlusions (1.6% vs 1.2%; OR 1.37, 95% CI 0.59 to 3.19, P=0.47) and in milder than in more severe strokes (NIHSS ≤15 vs >15: 2% vs 1.2%; OR 0.62, 95% CI 0.28 to 1.36, P=0.23).Conclusions Our study showed that the overall rate of conversion from MAC to GA during MT was low (1.6%) and, while higher in posterior circulation strokes, it was not predicted by either hemispheric dominance or stroke severity. Caution should be given before changing clinical practice during moments of crisis.Data are available upon reasonable request. Data Sharing: The unpublished data from this dataset is held by Grady Memorial Hospital / Emory University and the corresponding author. Requests for data sharing would be required to be discussed with them directly.