. 2018 Jul 3;91(1):e19-e25.

doi: 10.1212/WNL.0000000000005732. Epub 2018 Jun 1.

Conscious sedation or local anesthesia during endovascular treatment for acute ischemic stroke

Rob A van de Graaf¹, Noor Samuels², Maxim J H L Mulder², Ismail Eralp², Adriaan C G M van Es², Diederik W J Dippel², Aad van der Lugt², Bart J Emmer²; Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry Investigators

Collaborators, Affiliations

Collaborators

Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry Investigators:
Diederik W J Dippel, Aad van der Lugt, Charles B L M Majoie, Yvo B W E M Roos, Robert J van Oostenbrugge, Wim H van Zwam, Jelis Boiten, Jan Albert Vos, Ivo G H Jansen, Maxim J H L Mulder, Robert-Jan B Goldhoorn, Wouter J Schonewille, Jan Albert Vos, Charles B L M Majoie, Jonathan M Coutinho, Marieke J H Wermer, Marianne A A van Walderveen, Julie Staals, Wim H van Zwam, Jeannette Hofmeijer, Jasper M Martens, Geert J Lycklama À Nijeholt, Jelis Boiten, Bob Roozenbeek, Bart J Emmer, Sebastiaan F de Bruijn, Lukas C van Dijk, H Bart van der Worp, Rob H Lo, Ewoud J van Dijk, Hieronymus D Boogaarts, Paul L M de Kort, Jo J P Peluso, Jan S P van den Berg, Boudewijn A A M van Hasselt, Leo A M Aerden, René J Dallinga, Maarten Uyttenboogaart, Omid Eshghi, Tobien H C M L Schreuder, Roel J J Heijboer, Koos Keizer, Lonneke S F Yo, Heleen M den Hertog, Emiel J C Sturm, Charles B L M Majoie, Wim H van Zwam, Aad van der Lugt, Geert J Lycklama À Nijeholt, Marianne A A van Walderveen, Marieke E S Sprengers, Sjoerd F M Jenniskens, René van den Berg, Albert J Yoo, Ludo F M Beenen, Stefan D Roosendaal, BasF W van der Kallen, Ido R van den Wijngaard, Adriaan C G M van Es, Bart J Emmer, Jasper M Martens, Alida Postma, Lonneke S F Yo, Jan Albert Vos, Joseph C J Bot, Pieter-Jan van Doormaal, Diederik W J Dippel, Aad van der Lugt, Charles B L M Majoie, Yvo B W E M Roos, Robert J van Oostenbrugge, Wim H van Zwam, Geert J Lycklama À Nijeholt, Jelis Boiten, Jan Albert Vos, Wouter J Schonewille, Jeannette Hofmeijer, Jasper M Martens, H Bart van der Worp, Rob H Lo, Robert J van Oostenbrugge, Jeannette Hofmeijer, H Zwenneke Flach, Hester F Lingsma, Naziha El Ghannouti, Martin Sterrenberg, Corina Puppels, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Joke de Meris, Tamara Vermeulen, Annet Geerlings, Gina van Vemde, Tiny Simons, Cathelijn van Rijswijk, Gert Messchendorp, Hester Bongenaar, Karin Bodde, Sandra Kleijn, Jasmijn Lodico, Hanneke Droste, M Wollaert, D Jeurrissen, Ernas Bos, Yvonne Drabbe, Marjan Elfrink, Berber Zweedijk, Mostafa Khalilzada, Esmee Venema, Vicky Chalos, Kars C J Compagne, Ralph R Geuskens, Tim van Straaten, Saliha Ergezen, Roger R M Harmsma, Daan Muijres, Anouk de Jong, Wouter Hinsenveld, Olvert A Berkhemer, Anna M M Boers, J Huguet, P F C Groot, Marieke A Mens, Katinka R van Kranendonk, Kilian M Treurniet, Manon Kappelhof, Manon L Tolhuijsen, Heitor Alves

Affiliations

¹ From the Departments of Radiology (R.A.v.d.G., N.S., M.J.H.L.M., A.C.G.M.v.E., A.v.d.L., B.J.E.), Neurology (R.A.v.d.G., N.S., M.J.H.L.M., D.W.J.D.), and Anesthesia (I.E.), Erasmus MC, University Medical Center Rotterdam; and the Department of Radiology (B.J.E.), Academic Medical Center, Amsterdam, the Netherlands. r.a.vandegraaf@erasmusmc.nl.
² From the Departments of Radiology (R.A.v.d.G., N.S., M.J.H.L.M., A.C.G.M.v.E., A.v.d.L., B.J.E.), Neurology (R.A.v.d.G., N.S., M.J.H.L.M., D.W.J.D.), and Anesthesia (I.E.), Erasmus MC, University Medical Center Rotterdam; and the Department of Radiology (B.J.E.), Academic Medical Center, Amsterdam, the Netherlands.

PMID: 29858471
PMCID: PMC6537649
DOI: 10.1212/WNL.0000000000005732

Conscious sedation or local anesthesia during endovascular treatment for acute ischemic stroke

Rob A van de Graaf et al. Neurology. 2018.

. 2018 Jul 3;91(1):e19-e25.

doi: 10.1212/WNL.0000000000005732. Epub 2018 Jun 1.

Authors

Collaborators

Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry Investigators:
Diederik W J Dippel, Aad van der Lugt, Charles B L M Majoie, Yvo B W E M Roos, Robert J van Oostenbrugge, Wim H van Zwam, Jelis Boiten, Jan Albert Vos, Ivo G H Jansen, Maxim J H L Mulder, Robert-Jan B Goldhoorn, Wouter J Schonewille, Jan Albert Vos, Charles B L M Majoie, Jonathan M Coutinho, Marieke J H Wermer, Marianne A A van Walderveen, Julie Staals, Wim H van Zwam, Jeannette Hofmeijer, Jasper M Martens, Geert J Lycklama À Nijeholt, Jelis Boiten, Bob Roozenbeek, Bart J Emmer, Sebastiaan F de Bruijn, Lukas C van Dijk, H Bart van der Worp, Rob H Lo, Ewoud J van Dijk, Hieronymus D Boogaarts, Paul L M de Kort, Jo J P Peluso, Jan S P van den Berg, Boudewijn A A M van Hasselt, Leo A M Aerden, René J Dallinga, Maarten Uyttenboogaart, Omid Eshghi, Tobien H C M L Schreuder, Roel J J Heijboer, Koos Keizer, Lonneke S F Yo, Heleen M den Hertog, Emiel J C Sturm, Charles B L M Majoie, Wim H van Zwam, Aad van der Lugt, Geert J Lycklama À Nijeholt, Marianne A A van Walderveen, Marieke E S Sprengers, Sjoerd F M Jenniskens, René van den Berg, Albert J Yoo, Ludo F M Beenen, Stefan D Roosendaal, BasF W van der Kallen, Ido R van den Wijngaard, Adriaan C G M van Es, Bart J Emmer, Jasper M Martens, Alida Postma, Lonneke S F Yo, Jan Albert Vos, Joseph C J Bot, Pieter-Jan van Doormaal, Diederik W J Dippel, Aad van der Lugt, Charles B L M Majoie, Yvo B W E M Roos, Robert J van Oostenbrugge, Wim H van Zwam, Geert J Lycklama À Nijeholt, Jelis Boiten, Jan Albert Vos, Wouter J Schonewille, Jeannette Hofmeijer, Jasper M Martens, H Bart van der Worp, Rob H Lo, Robert J van Oostenbrugge, Jeannette Hofmeijer, H Zwenneke Flach, Hester F Lingsma, Naziha El Ghannouti, Martin Sterrenberg, Corina Puppels, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Joke de Meris, Tamara Vermeulen, Annet Geerlings, Gina van Vemde, Tiny Simons, Cathelijn van Rijswijk, Gert Messchendorp, Hester Bongenaar, Karin Bodde, Sandra Kleijn, Jasmijn Lodico, Hanneke Droste, M Wollaert, D Jeurrissen, Ernas Bos, Yvonne Drabbe, Marjan Elfrink, Berber Zweedijk, Mostafa Khalilzada, Esmee Venema, Vicky Chalos, Kars C J Compagne, Ralph R Geuskens, Tim van Straaten, Saliha Ergezen, Roger R M Harmsma, Daan Muijres, Anouk de Jong, Wouter Hinsenveld, Olvert A Berkhemer, Anna M M Boers, J Huguet, P F C Groot, Marieke A Mens, Katinka R van Kranendonk, Kilian M Treurniet, Manon Kappelhof, Manon L Tolhuijsen, Heitor Alves

Affiliations

¹ From the Departments of Radiology (R.A.v.d.G., N.S., M.J.H.L.M., A.C.G.M.v.E., A.v.d.L., B.J.E.), Neurology (R.A.v.d.G., N.S., M.J.H.L.M., D.W.J.D.), and Anesthesia (I.E.), Erasmus MC, University Medical Center Rotterdam; and the Department of Radiology (B.J.E.), Academic Medical Center, Amsterdam, the Netherlands. r.a.vandegraaf@erasmusmc.nl.
² From the Departments of Radiology (R.A.v.d.G., N.S., M.J.H.L.M., A.C.G.M.v.E., A.v.d.L., B.J.E.), Neurology (R.A.v.d.G., N.S., M.J.H.L.M., D.W.J.D.), and Anesthesia (I.E.), Erasmus MC, University Medical Center Rotterdam; and the Department of Radiology (B.J.E.), Academic Medical Center, Amsterdam, the Netherlands.

PMID: 29858471
PMCID: PMC6537649
DOI: 10.1212/WNL.0000000000005732

Abstract

Objective: To investigate the effect of conscious sedation (CS) on functional outcome and complication rates after intra-arterial treatment (IAT) for acute ischemic stroke (AIS) compared to the use of local anesthesia (LA) at the puncture site only.

Methods: Patients undergoing IAT for AIS with CS or LA in the Erasmus University Medical Center from March 2014 to June 2016 were included for analysis. The primary outcome was the score on the ordinal modified Rankin Scale (mRS). We compared CS to LA by ordinal logistic regression with covariate adjustment using propensity scoring.

Results: In 146 AIS patients treated with IAT, use of CS was associated with a shift towards worse mRS scores (odds ratio [OR] 0.4 [95% confidence interval (CI) 0.2-0.7]) compared to LA. Mortality after 90 days was higher in the CS group compared to the LA group (OR 2.3 [95% CI 1.0-5.2]). No differences between groups were noted with regard to procedure duration (8 minutes, β = 6.3 [95% CI -7.4 to 20.0]) or occurrence of procedure-related complications (OR 1.3 [95% CI 0.6-2.7]).

Conclusion: CS was associated with poor functional outcome and increased mortality rates compared to LA. Furthermore, CS did not reduce duration of intervention or interventional complications. CS during IAT for AIS is of no benefit if LA is considered safe.

Classification of evidence: This study provides Class II evidence, because of nonrandom allocation, that for patients with AIS undergoing IAT, LA rather than CS improves functional outcome.

PubMed Disclaimer

Figures

Figure. Flowchart of patients included from Erasmus Medical Center (Erasmus MC) in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke (MR CLEAN) registry from March 2014 to June 2016
CS = conscious sedation; LA = local anesthesia; mRS = modified Rankin Scale.

See this image and copyright information in PMC

Comment in

Optimal anesthetic strategy for endovascular stroke therapy: Begging for a good trial.
Rabinstein AA, Kallmes DF. Rabinstein AA, et al. Neurology. 2018 Jul 3;91(1):16-18. doi: 10.1212/WNL.0000000000005754. Epub 2018 Jun 1. Neurology. 2018. PMID: 29858470 No abstract available.

References

1. McDonagh DL, Olson DM, Kalia JS, Gupta R, Abou-Chebl A, Zaidat OO. Anesthesia and sedation practices among neurointerventionalists during acute ischemic stroke endovascular therapy. Front Neurol 2010;1:118. - PMC - PubMed
1. Powers WJ, Derdeyn CP, Biller J, et al. . 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015;46:3020–3035. - PubMed
1. Berkhemer OA, van den Berg LA, Fransen PS, et al. . The effect of anesthetic management during intra-arterial therapy for acute stroke in MR CLEAN. Neurology 2016;87:656–664. - PubMed
1. Campbell BCV, van Zwam WH, Goyal M, et al. . Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 2018;17:47–53. - PubMed
1. Schonenberger S, Uhlmann L, Hacke W, et al. . Effect of conscious sedation vs general anesthesia on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy: a randomized clinical trial. JAMA 2016;316:1986–1996. - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- MedlinePlus Health Information
Research Materials
- NCI CPTC Antibody Characterization Program

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Conscious sedation or local anesthesia during endovascular treatment for acute ischemic stroke

Collaborators

Affiliations

Conscious sedation or local anesthesia during endovascular treatment for acute ischemic stroke

Authors

Collaborators

Affiliations

Abstract

Figures

Comment in

References

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials