Document Type
Article
Publication Title
Neurology
Abstract
BACKGROUND AND OBJECTIVES: The effect of anesthesia choice on endovascular thrombectomy (EVT) outcomes is unclear. Collateral status on perfusion imaging may help identify the optimal anesthesia choice.
METHODS: In a pooled patient-level analysis of EXTEND-IA, EXTEND-IA TNK, EXTEND-IA TNK part II, and SELECT, EVT functional outcomes (modified Rankin Scale score distribution) were compared between general anesthesia (GA) vs non-GA in a propensity-matched sample. Furthermore, we evaluated the association of collateral flow on perfusion imaging, assessed by hypoperfusion intensity ratio (HIR) - Tmax > 10 seconds/Tmax > 6 seconds (good collaterals - HIR < 0.4, poor collaterals - HIR ≥ 0.4) on the association between anesthesia type and EVT outcomes.
RESULTS: Of 725 treated with EVT, 299 (41%) received GA and 426 (59%) non-GA. The baseline characteristics differed in presentation National Institutes of Health Stroke Scale score (median [interquartile range] GA: 18 [13-22], non-GA: 16 [11-20],
DISCUSSION: GA was associated with worse functional outcomes after EVT, particularly in patients with poor collaterals in a propensity score-matched analysis from a pooled patient-level cohort from 3 randomized trials and 1 prospective cohort study. The confounding by indication may persist despite the doubly robust nature of the analysis. These findings have implications for randomized trials of GA vs non-GA and may be of utility for clinicians when making anesthesia type choice.
CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that use of GA is associated with worse functional outcome in patients undergoing EVT.
TRIAL REGISTRATION INFORMATION: EXTEND-IA: ClinicalTrials.gov (NCT01492725); EXTEND-IA TNK: ClinicalTrials.gov (NCT02388061); EXTEND-IA TNK part II: ClinicalTrials.gov (NCT03340493); and SELECT: ClinicalTrials.gov (NCT02446587).
First Page
336
Last Page
336
DOI
10.1212/WNL.0000000000201384
Publication Date
1-17-2023
Recommended Citation
Sarraj, Amrou; Albers, Gregory W; Mitchell, Peter J; Hassan, Ameer E; Abraham, Michael G; Blackburn, Spiros; Sharma, Gagan; Yassi, Nawaf; Kleinig, Timothy J; Shah, Darshan G; Wu, Teddy Y; Hussain, Muhammad Shazam; Tekle, Wondwoseen G; Gutierrez, Santiago Ortega; Aghaebrahim, Amin Nima; Haussen, Diogo C; Toth, Gabor; Pujara, Deep; Budzik, Ronald F; Hicks, William; Vora, Nirav; Edgell, Randall C; Slavin, Sabreena; Lechtenberg, Colleen G; Maali, Laith; Qureshi, Abid; Rosterman, Lee; Abdulrazzak, Mohammad Ammar; AlMaghrabi, Tareq; Shaker, Faris; Mir, Osman; Arora, Ashish; Martin-Schild, Sheryl; Sitton, Clark W; Churilov, Leonid; Gupta, Rishi; Lansberg, Maarten G; Nogueira, Raul G; Grotta, James C; Donnan, Geoffrey Alan; Davis, Stephen M; and Campbell, Bruce C V, "Thrombectomy Outcomes With General vs Nongeneral Anesthesia: A Pooled Patient-Level Analysis From the EXTEND-IA Trials and SELECT Study." (2023). Neuroscience Articles. 6.
https://scholarlyworks.ohiohealth.com/neuroscience-articles/6