Outcomes with General Anesthesia Compared to Conscious Sedation for Endovascular Treatment of Medium Vessel Occlusions: Results of an International Multicentric Study

Răzvan Alexandru Radu^{1

2}, Vincent Costalat³, Michele Romoli⁴, Basel Musmar⁵, James E Siegler⁶, Sherief Ghozy⁷, Jane Khalife⁶, Hamza Salim⁵, Hamza Shaikh⁶, Nimer Adeeb⁵, Hugo H Cuellar-Saenz⁵, Ajith J Thomas⁶, Ramanathan Kadirvel⁷, Mohamad Abdalkader⁸, Piers Klein⁸, Thanh N Nguyen⁸, Jeremy J Heit⁹, Robert W Regenhardt¹⁰, Joshua D Bernstock^{10

11}, Aman B Patel¹⁰, James D Rabinov¹⁰, Christopher J Stapleton¹⁰, Nicole M Cancelliere¹², Thomas R Marotta¹², Vitor Mendes Pereira¹², Kareem El Naamani¹³, Abdelaziz Amllay¹³, Stavropoula I Tjoumakaris¹³, Pascal Jabbour¹³, Lukas Meyer¹⁴, Jens Fiehler¹⁴, Tobias D Faizy^{14

15}, Helena Guerreiro¹⁴, Anne Dusart¹⁶, Flavio Bellante¹⁶, Géraud Forestier¹⁷, Aymeric Rouchaud¹⁷, Charbel Mounayer¹⁷, Anna Luisa Kühn¹⁸, Ajit S Puri¹⁸, Christian Dyzmann¹⁹, Peter T Kan²⁰, Marco Colasurdo^{20

21}, Gaultier Marnat²², Jérôme Berge²², Xavier Barreau²², Igor Sibon²³, Simona Nedelcu²⁴, Nils Henninger^{24

25

26}, Takahiro Ota²⁷, Shogo Dofuku²⁷, Leonard L L Yeo²⁸, Benjamin Yq Tan^{28

29}, Anil Gopinathan^{28

30}, Juan Carlos Martinez-Gutierrez³¹, Sergio Salazar-Marioni³¹, Sunil Sheth³¹, Leonardo Renieri³², Carolina Capirossi³², Ashkan Mowla³³, Lina M Chervak³⁴, Achala Vagal³⁴, Priyank Khandelwal³⁵, Arundhati Biswas³⁶, Frédéric Clarençon^{37

30}, Mahmoud Elhorany^{37

38

30}, Kevin Premat^{37

30}, Iacopo Valente³⁹, Alessandro Pedicelli³⁹, Andrea M Alexandre³⁹, João Pedro Filipe⁴⁰, Ricardo Varela⁴¹, Miguel Quintero-Consuegra⁴², Nestor R Gonzalez⁴², Markus A Ymd⁴³, Jessica Jesser⁴³, Charlotte Weyland⁴³, Adrien Ter Schiphorst⁴⁴, Vivek Yedavalli⁴⁵, Pablo Harker⁴⁶, Yasmin Aziz⁴⁶, Benjamin Gory^{47

48}, Christian Paul Stracke¹⁵, Constantin Hecker⁴⁹, Monika Killer-Oberpfalzer⁴⁹, Christoph J Griessenauer⁴⁹, Cheng-Yang Hsieh⁵⁰, David S Liebeskind⁵¹, Illario Tancredi⁵², Robert Fahed⁵², Boris Lubicz⁵³, Muhammed Amir Essibayi⁵⁴, Amanda Baker⁵⁴, David Altschul⁵⁴, Luca Scarcia⁵⁵, Erwah Kalsoum⁵⁵, Adam A Dmytriw^{10

12}, Adrien Guenego⁵³; MAD-MT Consortium

Affiliations

¹ Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France. raduarazvan@yahoo.com.
² Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania. raduarazvan@yahoo.com.
³ Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
⁴ Neurology and Stroke Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy.
⁵ Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Louisiana, LA, USA.
⁶ Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
⁷ Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA.
⁸ Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
⁹ Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA.
¹⁰ Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
¹¹ Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA.
¹² Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.
¹³ Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
¹⁴ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁵ Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Munster, Germany.
¹⁶ Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
¹⁷ University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
¹⁸ Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
¹⁹ Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany.
²⁰ Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA.
²¹ Department of Interventional Radiology, Oregon Health and Science University, 97239, Portland, OR, USA.
²² Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
²³ Neurology Department, Bordeaux University Hospital, Bordeaux, France.
²⁴ Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
²⁵ Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA.
²⁶ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
²⁷ Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
²⁸ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
²⁹ Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.
³⁰ Division of Interventional Radiology, National University Hospital, Singapore, Singapore.
³¹ Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA.
³² Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy.
³³ Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), North State St, Suite 3300, 1200, Los Angeles, CA, USA.
³⁴ Department of Neurology and Radiology, University of Cincinnati, Cincinnati, USA.
³⁵ Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA.
³⁶ Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
³⁷ Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
³⁸ Neurology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
³⁹ UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS Roma, Rome, Italy.
⁴⁰ Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
⁴¹ Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
⁴² Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA.
⁴³ Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
⁴⁴ Department of Neurology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
⁴⁵ Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
⁴⁶ Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
⁴⁷ Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France.
⁴⁸ INSERM U1254, IADI, Université de Lorraine, 54511, Vandoeuvre-les-Nancy, France.
⁴⁹ Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.
⁵⁰ Neurology Department, Sin-Lau Hospital, Tainan, Taiwan, Province of China.
⁵¹ UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, California, USA.
⁵² Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada.
⁵³ Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.
⁵⁴ Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
⁵⁵ Department of Neuroradiology, Henri Mondor Hospital, Creteil, France.

PMID: 38687365
DOI: 10.1007/s00062-024-01415-1

Comparative Study

Outcomes with General Anesthesia Compared to Conscious Sedation for Endovascular Treatment of Medium Vessel Occlusions: Results of an International Multicentric Study

Răzvan Alexandru Radu et al. Clin Neuroradiol. 2024 Dec.

. 2024 Dec;34(4):761-769.

doi: 10.1007/s00062-024-01415-1. Epub 2024 Apr 30.

Authors

Affiliations

¹ Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France. raduarazvan@yahoo.com.
² Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania. raduarazvan@yahoo.com.
³ Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
⁴ Neurology and Stroke Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy.
⁵ Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Louisiana, LA, USA.
⁶ Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
⁷ Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA.
⁸ Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
⁹ Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, CA, USA.
¹⁰ Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA.
¹¹ Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA.
¹² Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.
¹³ Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
¹⁴ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁵ Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Munster, Germany.
¹⁶ Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
¹⁷ University Hospital of Limoges, Neuroradiology Department, Dupuytren, Université de Limoges, XLIM CNRS, UMR 7252, Limoges, France.
¹⁸ Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
¹⁹ Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany.
²⁰ Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA.
²¹ Department of Interventional Radiology, Oregon Health and Science University, 97239, Portland, OR, USA.
²² Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
²³ Neurology Department, Bordeaux University Hospital, Bordeaux, France.
²⁴ Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
²⁵ Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA.
²⁶ Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
²⁷ Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
²⁸ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
²⁹ Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.
³⁰ Division of Interventional Radiology, National University Hospital, Singapore, Singapore.
³¹ Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA.
³² Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy.
³³ Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), North State St, Suite 3300, 1200, Los Angeles, CA, USA.
³⁴ Department of Neurology and Radiology, University of Cincinnati, Cincinnati, USA.
³⁵ Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA.
³⁶ Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
³⁷ Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France.
³⁸ Neurology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
³⁹ UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS Roma, Rome, Italy.
⁴⁰ Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
⁴¹ Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
⁴² Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA.
⁴³ Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
⁴⁴ Department of Neurology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
⁴⁵ Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD, USA.
⁴⁶ Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
⁴⁷ Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France.
⁴⁸ INSERM U1254, IADI, Université de Lorraine, 54511, Vandoeuvre-les-Nancy, France.
⁴⁹ Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University Salzburg, Salzburg, Austria.
⁵⁰ Neurology Department, Sin-Lau Hospital, Tainan, Taiwan, Province of China.
⁵¹ UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, California, USA.
⁵² Department of Medicine, Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada.
⁵³ Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.
⁵⁴ Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
⁵⁵ Department of Neuroradiology, Henri Mondor Hospital, Creteil, France.

PMID: 38687365
DOI: 10.1007/s00062-024-01415-1

Abstract

Background: Optimal anesthetic strategy for the endovascular treatment of stroke is still under debate. Despite scarce data concerning anesthetic management for medium and distal vessel occlusions (MeVOs) some centers empirically support a general anesthesia (GA) strategy in these patients.

Methods: We conducted an international retrospective study of MeVO cases. A propensity score matching algorithm was used to mitigate potential differences across patients undergoing GA and conscious sedation (CS). Comparisons in clinical and safety outcomes were performed between the two study groups GA and CS. The favourable outcome was defined as a modified Rankin Scale (mRS) 0-2 at 90 days. Safety outcomes were 90-days mortality and symptomatic intracranial hemorrhage (sICH). Predictors of a favourable outcome and sICH were evaluated with backward logistic regression.

Results: After propensity score matching 668 patients were included in the CS and 264 patients in the GA group. In the matched cohort, either strategy CS or GA resulted in similar rates of good functional outcomes (50.1% vs. 48.4%), and successful recanalization (89.4% vs. 90.2%). The GA group had higher rates of 90-day mortality (22.6% vs. 16.5%, p < 0.041) and sICH (4.2% vs. 0.9%, p = 0.001) compared to the CS group. Backward logistic regression did not identify GA vs CS as a predictor of good functional outcome (OR for GA vs CS = 0.95 (0.67-1.35)), but GA remained a significant predictor of sICH (OR = 5.32, 95% CI 1.92-14.72).

Conclusion: Anaesthetic strategy in MeVOs does not influence favorable outcomes or final successful recanalization rates, however, GA may be associated with an increased risk of sICH and mortality.

Keywords: Anesthesia; MeVO; Outcomes research; Reperfusion; Stroke; Thrombectomy.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest R.W. Regenhardt serves on a DSMB for a trial sponsored by Rapid Medical, serves as site PI for studies sponsored by Penumbra and Microvention, and receives stroke research grant funding from the National Institutes of Health, Society of Vascular and Interventional Neurology, and Heitman Stroke Foundation. A. Guenego reports consultancy for Rapid Medical and Phenox, not directly related to the present work. F. Clarençon reports conflicts of interest with Medtronic, Balt Extrusion (consultant), ClinSearch (core lab), Penumbra, Stryker (payment for reading) and Artedrone (Board) ; all not directly related to the present work. N. Henninger received support from NINDS NS131756, during the conduct of the study. D.S. Liebeskind is consultant as Imaging Core Lab to Cerenovus, Genentech, Medtronic, Stryker, Rapid Medical. T.N. Nguyen reports advisory board with Idorsia. L.L.L. Yeo reports Advisory work for AstraZeneca, Substantial support from NMRC Singapore and is a medical advisor for See-mode, Cortiro and Sunbird Bio, with equity in Ceroflo. All unrelated to the present work. C.J. Griessenauer reports a proctoring agreement with Medtronic and research funding by Penumbra. G. Marnat reports conflicts of interest with Microvention Europe, Stryker Neurovascular, Balt (consulting), Medtronic, Johnson & Johnson and Phenox (paid lectures), all not directly related to the present work. I. Sibon reports conflict of interest with Medtronic, Sanofi, Bayer, Boehringer-Ingelheim, Novartis, Novo-nordisk, BMS-Pfizer (Board and paid lectures), all not directly related to the present work. V. Yedavalli is a consultant for RAPID (Ischemaview, Menlo Park, CA). A. Vagal is a consultant for Viz AI. She is also PI of the Imaging core lab for the ENDOLOW study funded by Cerenovus (monies go to the institution). A. Gopinathan reports conflicts of interest with Microvention, Stryker Neurovascular, Medtronic, BD, and Penumbra (paid lectures, workshops, and proctoring), all not directly related to the present work. R. A. Radu, V. Costalat, M. Romoli, B. Musmar, J.E. Siegler, S. Ghozy, J. Khalife, H. Salim, H. Shaikh, N. Adeeb, H.H. Cuellar-Saenz, A.J. Thomas, R. Kadirvel, M. Abdalkader, P. Klein, J.J. Heit, J.D. Bernstock, A.B. Patel, J.D. Rabinov, C.J. Stapleton, N.M. Cancelliere, T.R. Marotta, V. Mendes Pereira, K. El Naamani, A. Amllay, S.I. Tjoumakaris, P. Jabbour, L. Meyer, J. Fiehler, T.D. Faizy, H. Guerreiro, A. Dusart, F. Bellante, G. Forestier, A. Rouchaud, C. Mounayer, A.L. Kühn, A.S. Puri, C. Dyzmann, P.T. Kan, M. Colasurdo, J. Berge, X. Barreau, S. Nedelcu, T. Ota, S. Dofuku, B.Y. Tan, J.C. Martinez-Gutierrez, S. Salazar-Marioni, S. Sheth, L. Renieri, C. Capirossi, A. Mowla, L.M. Chervak, P. Khandelwal, A. Biswas, M. Elhorany, K. Premat, I. Valente, A. Pedicelli, A.M. Alexandre, J.P. Filipe, R. Varela, M. Quintero-Consuegra, N.R. Gonzalez, M.A. YMD, J. Jesser, C. Weyland, A. ter Schiphorst, P. Harker, Y. Aziz, B. Gory, C. Paul Stracke, C. Hecker, M. Killer-Oberpfalzer, C.-Y. Hsieh, I. Tancredi, R. Fahed, B. Lubicz, M.A. Essibayi, A. Baker, D. Altschul, L. Scarcia, E. Kalsoum and A.A. Dmytriw for the MAD-MT Consortium declare that they have no competing interests.

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Outcomes with General Anesthesia Compared to Conscious Sedation for Endovascular Treatment of Medium Vessel Occlusions: Results of an International Multicentric Study

Affiliations

Outcomes with General Anesthesia Compared to Conscious Sedation for Endovascular Treatment of Medium Vessel Occlusions: Results of an International Multicentric Study

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources