Impact of Anesthetic Management on Safety and Outcomes Following Mechanical Thrombectomy for Ischemic Stroke in SWIFT PRIME Cohort

Omer F Eker; Jeffrey L Saver; Mayank Goyal; Reza Jahan; Elad I Levy; Raul G Nogueira; Dileep R Yavagal; Alain Bonafé; SWIFT PRIME investigators

doi:10.3389/fneur.2018.00702

Impact of Anesthetic Management on Safety and Outcomes Following Mechanical Thrombectomy for Ischemic Stroke in SWIFT PRIME Cohort

Front Neurol. 2018 Aug 29:9:702. doi: 10.3389/fneur.2018.00702. eCollection 2018.

Authors

Omer F Eker¹, Jeffrey L Saver², Mayank Goyal³, Reza Jahan⁴, Elad I Levy⁵, Raul G Nogueira⁶, Dileep R Yavagal⁷, Alain Bonafé⁸; SWIFT PRIME investigators

Affiliations

¹ Department of Neuroradiology, P. Wertheimer Hospital, Hospices Civils de Lyon, Lyon, France.
² Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
³ Department of Radiology and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
⁴ Division of Interventional Neuroradiology, University of California, Los Angeles, Los Angeles, CA, United States.
⁵ Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY, United States.
⁶ Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States.
⁷ Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami, FL, United States.
⁸ Department of Neuroradiology, Hôpital Gui-de-Chauliac, CHU de Montpellier, Montpellier, France.

Abstract

Background and purpose: The optimal anesthetic management of acute ischemic stroke patients during mechanical thrombectomy (MT) remains controversial. In this post-hoc analysis, we investigated the impact of anesthesia type on clinical outcomes in patients included in SWIFT PRIME trial. Methods: Ninety-seven patients treated with MT were included. Patients treated in centers with general anesthesia (GA) policy (n = 32) were compared with those treated in centers with conscious sedation (CS) policy (n = 65). Primary outcomes studied included times to treatment initiation (TTI), rates of successful recanalization (TICI 2b/3), and functional independence (mRS 0-2 at 90 days). Secondary outcomes were adverse events, lowest systolic and diastolic blood pressures (LSBP and LDBP) during MT. Univariate analysis and multivariate regression logistic modeling were conducted. Results: The GA-policy and CS-policy groups presented comparable TTI (94 ± 36 min vs. 102 ± 48 min; p = 0.44), rates of TICI 2b/3 recanalization (22/32 [68.8%] vs. 51/65 [78.5%]; p = 0.32). CS-policy was associated to higher rate of functional independence than GA-policy, but the difference was not significant (43/65 [66.2%] vs. 16/32 [50.0%]; p = 0.18). GA-policy patients had a higher rate of postoperative pneumonia (11/32 [34.4%] vs. 8/65 [12.3%]; p = 0.02) and lower LSBP (110 [30,160] mmHg vs. 119 [77,170] mmHg; p = 0.03) and LDBP (55 (15,75) mmHg vs. 67 [40,121]; p < 0.001). When corrected for differences in baseline characteristics, GA-policy was associated with lower rate of functional independence (OR 0.32; p = 0.05). A 10-point increase in perprocedural LDBP was associated with an increased likelihood of favorable outcome (OR 1.51; p = 0.01). Conclusions: GA-policy for MT presented comparable TTI and rates of successful revascularization to CS-policy. However, GA-policy was associated with lower rates of functional independence and with higher incidence of perprocedural hypotension and postoperative pneumonia. Clinical Trial Registration: URL-http://www.clinicaltrials.gov. Unique identifier: NCT01657461.

Keywords: acute ischemic stroke; blood pressure; conscious sedation; general anesthesia; mechanical thrombectomy.

Associated data

ClinicalTrials.gov/NCT01657461