Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN registry

Robert Jan B. Goldhoorn*, Marie Louise Elisabeth Bernsen, Jeannette Hofmeijer, J. Martens, Hester Lingsma, Diederik W.J. Dippel, Aad J. van der Lugt, Wolfgang Buhre, Yvo Roos, Charles B.L.M. Majoie, Jan Albert Vos, Jelis Boiten, Bart J. Emmer, Robert J. van Oostenbrugge, Wim H. van Zwam

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective To compare outcomes after endovascular treatment (EVT) for acute ischemic stroke with 3 different types of anesthetic management in clinical practice, as anesthetic management may influence functional outcome.

Methods Data of patients with an anterior circulation occlusion, included in the Dutch nationwide, prospective Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry between March 2014 and June 2016, were analyzed. Patients were divided into 3 groups defined by anesthetic technique performed during EVT: local anesthesia only (LA), general anesthesia (GA), or conscious sedation (CS). Primary outcome was the modified Rankin Scale score at 90 days. To compare functional outcome between groups, we estimated a common odds ratio (OR) with ordinal logistic regression, adjusted for age, sex, prestroke modified Rankin Scale score, baseline NIH Stroke Scale score, collaterals, and time from onset to arrival at intervention center.

Results A total of 1,376 patients were included. Performed anesthetic technique was LA in 821 (60%), GA in 381 (28%), and CS in 174 (13%) patients. Compared to LA, both GA and CS were associated with worse functional outcome on the modified Rankin Scale score at 90 days (GA cORadj 0.75; 95% confidence interval [CI] 0.58–0.97; CS cORadj 0.45; 95% CI 0.33–0.62). CS was associated with worse functional outcome than GA (cORadj 0.60; 95% CI 0.42–0.87).

Conclusions LA is associated with better functional outcome than systemic sedation in patients undergoing EVT for acute ischemic stroke. Whereas LA had a clear advantage over CS, this was less prominent compared to GA.

Classification of evidence This study provides Class III evidence that for patients with acute ischemic stroke undergoing EVT, LA improves functional outcome compared to GA or CS.
Original languageEnglish
JournalNeurology
Volume94
Issue number1
Early online date5 Dec 2019
DOIs
Publication statusPublished - 7 Jan 2020

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Conscious Sedation
General Anesthesia
Local Anesthesia
Registries
Anesthetics
Stroke
Confidence Intervals
Therapeutics
Netherlands
Randomized Controlled Trials
Logistic Models
Odds Ratio

Cite this

Goldhoorn, R. J. B., Bernsen, M. L. E., Hofmeijer, J., Martens, J., Lingsma, H., Dippel, D. W. J., ... van Zwam, W. H. (2020). Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN registry. Neurology, 94(1). https://doi.org/10.1212/WNL.0000000000008674
Goldhoorn, Robert Jan B. ; Bernsen, Marie Louise Elisabeth ; Hofmeijer, Jeannette ; Martens, J. ; Lingsma, Hester ; Dippel, Diederik W.J. ; van der Lugt, Aad J. ; Buhre, Wolfgang ; Roos, Yvo ; Majoie, Charles B.L.M. ; Vos, Jan Albert ; Boiten, Jelis ; Emmer, Bart J. ; van Oostenbrugge, Robert J. ; van Zwam, Wim H. / Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN registry. In: Neurology. 2020 ; Vol. 94, No. 1.
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title = "Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN registry",
abstract = "Objective To compare outcomes after endovascular treatment (EVT) for acute ischemic stroke with 3 different types of anesthetic management in clinical practice, as anesthetic management may influence functional outcome.Methods Data of patients with an anterior circulation occlusion, included in the Dutch nationwide, prospective Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry between March 2014 and June 2016, were analyzed. Patients were divided into 3 groups defined by anesthetic technique performed during EVT: local anesthesia only (LA), general anesthesia (GA), or conscious sedation (CS). Primary outcome was the modified Rankin Scale score at 90 days. To compare functional outcome between groups, we estimated a common odds ratio (OR) with ordinal logistic regression, adjusted for age, sex, prestroke modified Rankin Scale score, baseline NIH Stroke Scale score, collaterals, and time from onset to arrival at intervention center.Results A total of 1,376 patients were included. Performed anesthetic technique was LA in 821 (60{\%}), GA in 381 (28{\%}), and CS in 174 (13{\%}) patients. Compared to LA, both GA and CS were associated with worse functional outcome on the modified Rankin Scale score at 90 days (GA cORadj 0.75; 95{\%} confidence interval [CI] 0.58–0.97; CS cORadj 0.45; 95{\%} CI 0.33–0.62). CS was associated with worse functional outcome than GA (cORadj 0.60; 95{\%} CI 0.42–0.87).Conclusions LA is associated with better functional outcome than systemic sedation in patients undergoing EVT for acute ischemic stroke. Whereas LA had a clear advantage over CS, this was less prominent compared to GA.Classification of evidence This study provides Class III evidence that for patients with acute ischemic stroke undergoing EVT, LA improves functional outcome compared to GA or CS.",
author = "Goldhoorn, {Robert Jan B.} and Bernsen, {Marie Louise Elisabeth} and Jeannette Hofmeijer and J. Martens and Hester Lingsma and Dippel, {Diederik W.J.} and {van der Lugt}, {Aad J.} and Wolfgang Buhre and Yvo Roos and Majoie, {Charles B.L.M.} and Vos, {Jan Albert} and Jelis Boiten and Emmer, {Bart J.} and {van Oostenbrugge}, {Robert J.} and {van Zwam}, {Wim H.}",
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doi = "10.1212/WNL.0000000000008674",
language = "English",
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journal = "Neurology",
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Goldhoorn, RJB, Bernsen, MLE, Hofmeijer, J, Martens, J, Lingsma, H, Dippel, DWJ, van der Lugt, AJ, Buhre, W, Roos, Y, Majoie, CBLM, Vos, JA, Boiten, J, Emmer, BJ, van Oostenbrugge, RJ & van Zwam, WH 2020, 'Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN registry', Neurology, vol. 94, no. 1. https://doi.org/10.1212/WNL.0000000000008674

Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN registry. / Goldhoorn, Robert Jan B.; Bernsen, Marie Louise Elisabeth; Hofmeijer, Jeannette ; Martens, J.; Lingsma, Hester; Dippel, Diederik W.J.; van der Lugt, Aad J.; Buhre, Wolfgang; Roos, Yvo; Majoie, Charles B.L.M.; Vos, Jan Albert; Boiten, Jelis; Emmer, Bart J.; van Oostenbrugge, Robert J.; van Zwam, Wim H.

In: Neurology, Vol. 94, No. 1, 07.01.2020.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN registry

AU - Goldhoorn, Robert Jan B.

AU - Bernsen, Marie Louise Elisabeth

AU - Hofmeijer, Jeannette

AU - Martens, J.

AU - Lingsma, Hester

AU - Dippel, Diederik W.J.

AU - van der Lugt, Aad J.

AU - Buhre, Wolfgang

AU - Roos, Yvo

AU - Majoie, Charles B.L.M.

AU - Vos, Jan Albert

AU - Boiten, Jelis

AU - Emmer, Bart J.

AU - van Oostenbrugge, Robert J.

AU - van Zwam, Wim H.

PY - 2020/1/7

Y1 - 2020/1/7

N2 - Objective To compare outcomes after endovascular treatment (EVT) for acute ischemic stroke with 3 different types of anesthetic management in clinical practice, as anesthetic management may influence functional outcome.Methods Data of patients with an anterior circulation occlusion, included in the Dutch nationwide, prospective Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry between March 2014 and June 2016, were analyzed. Patients were divided into 3 groups defined by anesthetic technique performed during EVT: local anesthesia only (LA), general anesthesia (GA), or conscious sedation (CS). Primary outcome was the modified Rankin Scale score at 90 days. To compare functional outcome between groups, we estimated a common odds ratio (OR) with ordinal logistic regression, adjusted for age, sex, prestroke modified Rankin Scale score, baseline NIH Stroke Scale score, collaterals, and time from onset to arrival at intervention center.Results A total of 1,376 patients were included. Performed anesthetic technique was LA in 821 (60%), GA in 381 (28%), and CS in 174 (13%) patients. Compared to LA, both GA and CS were associated with worse functional outcome on the modified Rankin Scale score at 90 days (GA cORadj 0.75; 95% confidence interval [CI] 0.58–0.97; CS cORadj 0.45; 95% CI 0.33–0.62). CS was associated with worse functional outcome than GA (cORadj 0.60; 95% CI 0.42–0.87).Conclusions LA is associated with better functional outcome than systemic sedation in patients undergoing EVT for acute ischemic stroke. Whereas LA had a clear advantage over CS, this was less prominent compared to GA.Classification of evidence This study provides Class III evidence that for patients with acute ischemic stroke undergoing EVT, LA improves functional outcome compared to GA or CS.

AB - Objective To compare outcomes after endovascular treatment (EVT) for acute ischemic stroke with 3 different types of anesthetic management in clinical practice, as anesthetic management may influence functional outcome.Methods Data of patients with an anterior circulation occlusion, included in the Dutch nationwide, prospective Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry between March 2014 and June 2016, were analyzed. Patients were divided into 3 groups defined by anesthetic technique performed during EVT: local anesthesia only (LA), general anesthesia (GA), or conscious sedation (CS). Primary outcome was the modified Rankin Scale score at 90 days. To compare functional outcome between groups, we estimated a common odds ratio (OR) with ordinal logistic regression, adjusted for age, sex, prestroke modified Rankin Scale score, baseline NIH Stroke Scale score, collaterals, and time from onset to arrival at intervention center.Results A total of 1,376 patients were included. Performed anesthetic technique was LA in 821 (60%), GA in 381 (28%), and CS in 174 (13%) patients. Compared to LA, both GA and CS were associated with worse functional outcome on the modified Rankin Scale score at 90 days (GA cORadj 0.75; 95% confidence interval [CI] 0.58–0.97; CS cORadj 0.45; 95% CI 0.33–0.62). CS was associated with worse functional outcome than GA (cORadj 0.60; 95% CI 0.42–0.87).Conclusions LA is associated with better functional outcome than systemic sedation in patients undergoing EVT for acute ischemic stroke. Whereas LA had a clear advantage over CS, this was less prominent compared to GA.Classification of evidence This study provides Class III evidence that for patients with acute ischemic stroke undergoing EVT, LA improves functional outcome compared to GA or CS.

U2 - 10.1212/WNL.0000000000008674

DO - 10.1212/WNL.0000000000008674

M3 - Article

VL - 94

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 1

ER -