Anaesthesia modality on endovascular therapy outcomes in patients with large infarcts: a post hoc analysis of the ANGEL-ASPECT trial

Abstract

Objectives: Endovascular therapy (EVT) now penetrates the once obscure realm of large infarct core volume acute ischaemic stroke (LICV-AIS). This research aimed to investigate the potential correlation between different anaesthetic approaches and post-EVT outcomes in LICV-AIS patients.

Methods: Between October 2020 and May 2022, the China ANGEL-Alberta Stroke Programme Early CT Score (ASPECT) trial studied patients with LICV-AIS, randomly assigning them to the best medical management (BMM) or BMM with EVT. This post hoc subgroup analysis categorised subjects receiving BMM with EVT into general anaesthesia (GA) and non-GA groups based on anaesthesia type. We applied multivariable logistic regression to evaluate the relationship between anaesthesia during EVT and patient functional outcomes, as measured by the modified Rankin scale (mRS), in addition to the occurrence of complications. Further adjustment for selection bias was achieved through propensity score matching (PSM).

Results: In total, 230 patients with LICV-AIS were enrolled (GA 84 vs Non-GA 146). No significant difference was observed between the two groups in terms of the proportion of patients who achieved an mRS score of 0-2 at 90 days (27.4% for the GA group vs 31.5% for the non-GA group, p=0.51). However, the GA group had significantly longer median surgical times (142 min vs 122 min, p=0.03). Furthermore, GA was associated with an increased risk of postoperative pneumonia (adjusted OR 2.03, 95% CI 1.04 to 3.98). The results of PSM analysis agreed with the results of the multivariate regression analysis. No significant difference in intracranial haemorrhage incidence or mortality rate was observed between the groups.

Conclusion: This post hoc analysis of subgroups of the ANGEL-ASPECT trial suggested that there may be no significant association between the choice of anaesthesia and neurological outcomes in LICV-AIS patients. However, compared with non-GA, GA prolongs the duration of EVT and is associated with a greater postoperative pneumonia risk.

Trial registration number: NCT04551664.

Keywords: Ischemic Stroke; Stroke.

Figure 1. Anaesthesia technique-based analysis of the participant screening flow chart from the ANGEL-ASPECT Trial. ASPECT, Alberta Stroke Programme Early CT Score; PSM, propensity score matching.

Figure 2. Systolic blood pressure (SBP) at critical time points. (A) After groin puncture. (B) After final angiography. GA, general anaesthesia.

Figure 3. Distribution of 90-day mRS scales between the general and non-general anaesthesia groups. (A) Initial cohort. (B) Propensity score matching cohort. mRS, modified Rankin scale.

Figure 4. Exploratory subgroup analysis of the primary outcome. ASPECTS, Alberta Stroke Programme Early CT score; GA, general anaesthesia; NIHSS, National Institutes of Health Stroke Scale.