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General Anesthesia Versus Conscious Sedation for Endovascular Treatment of Acute Ischemic Stroke: The AnStroke Trial (Anesthesia During Stroke).

Journal article
Authors Pia Henden Löwhagen
Alexandros Rentzos
Jan-Erik Karlsson
Lars Rosengren
Birgitta Leiram
Henrik Sundeman
Dennis Dunker
Kunigunde Schnabel
Gunnar Wikholm
Mikael Hellström
Sven-Erik Ricksten
Published in Stroke
Volume 48
Issue 6
Pages 1601-1607
ISSN 1524-4628
Publication year 2017
Published at Institute of Neuroscience and Physiology
Institute of Clinical Sciences, Section for Anesthesiology, Biomaterials and Orthopaedics. Department of Anesthesiology and Intensive care
Institute of Clinical Sciences, Section for Oncology, Radiation Physics, Radiology and Urology, Department of Radiology
Pages 1601-1607
Language en
Links dx.doi.org/10.1161/STROKEAHA.117.01...
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Clinical Medicine, Radiology

Abstract

Retrospective studies have found that patients receiving general anesthesia for endovascular treatment in acute ischemic stroke have worse neurological outcome compared with patients receiving conscious sedation. In this prospective randomized single-center study, we investigated the impact of anesthesia technique on neurological outcome in acute ischemic stroke patients.Ninety patients receiving endovascular treatment for acute ischemic stroke in 2013 to 2016 were included and randomized to general anesthesia or conscious sedation. Difference in neurological outcome at 3 months, measured as modified Rankin Scale score, was analyzed (primary outcome) and early neurological improvement of National Institutes of Health Stroke Scale and cerebral infarction volume. Age, sex, comorbidities, admission National Institutes of Health Stroke Scale score, intraprocedural blood pressure, blood glucose, Paco2 and Pco2 modified Thrombolysis in Cerebral Ischemia score, and relevant time intervals were recorded.In the general anesthesia group 19 of 45 patients (42.2%) and in the conscious sedation group 18 of 45 patients (40.0%) achieved a modified Rankin Scale score ≤2 (P=1.00) at 3 months, with no differences in intraoperative blood pressure decline from baseline (P=0.57); blood glucose (P=0.94); PaCO2 (P=0.68); time intervals (P=0.78); degree of successful recanalization, 91.1% versus 88.9% (P=1.00); National Institutes of Health Stroke Scale score at 24 hours 8 (3-5) versus 9 (2-15; P=0.60); infarction volume, 20 (10-100) versus 20(10-54) mL (P=0.53); and hospital mortality (13.3% in both groups; P=1.00).In endovascular treatment for acute ischemic stroke, no difference was found between general anesthesia and conscious sedation in neurological outcome 3 months after stroke.URL: https://www.clinicaltrials.gov. Unique identifier: NCT01872884.

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