Impact of General Anesthesia on Safety and Outcomes in the Endovascular Arm of Interventional Management of Stroke (IMS) III Trial
BACKGROUND AND PURPOSE—General anesthesia (GA) for endovascular therapy (EVT) of acute ischemic stroke may be associated with worse outcomes. METHODS—The Interventional Management of Stroke III trial randomized patients within 3 hours of acute ischemic stroke onset to intravenous tissue-type plasmin...
Gespeichert in:
| Veröffentlicht in: | Stroke (1970) 2015-08, Vol.46 (8), p.2142-2148 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 2148 |
|---|---|
| container_issue | 8 |
| container_start_page | 2142 |
| container_title | Stroke (1970) |
| container_volume | 46 |
| creator | Abou-Chebl, Alex Yeatts, Sharon D Yan, Bernard Cockroft, Kevin Goyal, Mayank Jovin, Tudor Khatri, Pooja Meyers, Phillip Spilker, Judith Sugg, Rebecca Wartenberg, Katja E Tomsick, Tom Broderick, Joe Hill, Michael D |
| description | BACKGROUND AND PURPOSE—General anesthesia (GA) for endovascular therapy (EVT) of acute ischemic stroke may be associated with worse outcomes.
METHODS—The Interventional Management of Stroke III trial randomized patients within 3 hours of acute ischemic stroke onset to intravenous tissue-type plasminogen activator±EVT. GA use within 7 hours of stroke onset was recorded per protocol. Good outcome was defined as 90-day modified Rankin Scale ≤2. A multivariable analysis adjusting for dichotomized National Institutes of Health Stroke Scale (NIHSS; 8–19 versus ≥20), age, and time from onset to groin puncture was performed.
RESULTS—Four hundred thirty-four patients were randomized to EVT, 269 (62%) were treated under local anesthesia and 147 (33.9%) under GA; 18 (4%) were undetermined. The 2 groups were comparable except for median baseline NIHSS (16 local anesthesia versus 18 GA; P |
| doi_str_mv | 10.1161/STROKEAHA.115.008761 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1700105792</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1700105792</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4021-2ffcdc2dd85b6092558071008503410531adfaa9bb1ba867f3aa1f93d9dbb7913</originalsourceid><addsrcrecordid>eNp9kMFu1DAQhi0EokvhDRDysRxSPE6cxMeoWtqIViuxyzmaxDYb6tiLnbTqlSfHqy09crJ--ZtvND8hH4FdApTwZbv7vvm2bm6aFMUlY3VVwiuyAsGLrCh5_ZqsGMtlxgspz8i7GH8xxnhei7fkjJeQ18DFivxppwMOM_WGXmunA1raOB3nvY4jUu_oFo2enyg6RTfLPPhJRzo6mgC6dso_YBwWi4E2YTpKWjfr8KDdPHqXXHfo8KeeUj5-bufg7zW9aO-2n2nbtnQXRrTvyRuDNuoPz-85-fF1vbu6yW431-1Vc5sNBeOQcWMGNXClatGXTHIhalZBuluwvAAmckBlEGXfQ491WZkcEYzMlVR9X0nIz8nFyXsI_veSbuymMQ7aWnTaL7GDirHkqSRPaHFCh-BjDNp0hzBOGJ46YN2x_e6l_RRFd2o_jX163rD0k1YvQ__qTkB9Ah69TT3Fe7s86tDtNdp5_3_3X4Pikqs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1700105792</pqid></control><display><type>article</type><title>Impact of General Anesthesia on Safety and Outcomes in the Endovascular Arm of Interventional Management of Stroke (IMS) III Trial</title><source>MEDLINE</source><source>American Heart Association Journals</source><source>Journals@Ovid Complete</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Abou-Chebl, Alex ; Yeatts, Sharon D ; Yan, Bernard ; Cockroft, Kevin ; Goyal, Mayank ; Jovin, Tudor ; Khatri, Pooja ; Meyers, Phillip ; Spilker, Judith ; Sugg, Rebecca ; Wartenberg, Katja E ; Tomsick, Tom ; Broderick, Joe ; Hill, Michael D</creator><creatorcontrib>Abou-Chebl, Alex ; Yeatts, Sharon D ; Yan, Bernard ; Cockroft, Kevin ; Goyal, Mayank ; Jovin, Tudor ; Khatri, Pooja ; Meyers, Phillip ; Spilker, Judith ; Sugg, Rebecca ; Wartenberg, Katja E ; Tomsick, Tom ; Broderick, Joe ; Hill, Michael D</creatorcontrib><description>BACKGROUND AND PURPOSE—General anesthesia (GA) for endovascular therapy (EVT) of acute ischemic stroke may be associated with worse outcomes.
METHODS—The Interventional Management of Stroke III trial randomized patients within 3 hours of acute ischemic stroke onset to intravenous tissue-type plasminogen activator±EVT. GA use within 7 hours of stroke onset was recorded per protocol. Good outcome was defined as 90-day modified Rankin Scale ≤2. A multivariable analysis adjusting for dichotomized National Institutes of Health Stroke Scale (NIHSS; 8–19 versus ≥20), age, and time from onset to groin puncture was performed.
RESULTS—Four hundred thirty-four patients were randomized to EVT, 269 (62%) were treated under local anesthesia and 147 (33.9%) under GA; 18 (4%) were undetermined. The 2 groups were comparable except for median baseline NIHSS (16 local anesthesia versus 18 GA; P<0.0001). The GA group was less likely to achieve a good outcome (adjusted relative risk, 0.68; confidence interval, 0.52–0.90; P=0.0056) and had increased in-hospital mortality (adjusted relative risk, 2.84; confidence interval, 1.65–4.91; P=0.0002). Those with medically indicated GA had worse outcomes (adjusted relative risk, 0.49; confidence interval, 0.30–0.81; P=0.005) and increased mortality (relative risk, 3.93; confidence interval, 2.18–7.10; P<0.0001) with a trend for higher mortality with routine GA. There was no significant difference in the adjusted risks of subarachnoid hemorrhage (P=0.32) or symptomatic intracerebral hemorrhage (P=0.37).
CONCLUSIONS—GA was associated with worse neurological outcomes and increased mortality in the EVT arm; this was primarily true among patients with medical indications for GA. Relative risk estimates, though not statistically significant, suggest reduced risk for subarachnoid hemorrhage and symptomatic intracerebral hemorrhage under local anesthesia. Although the reasons for these associations are not clear, these data support the use of local anesthesia when possible during EVT.
CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT00359424.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.115.008761</identifier><identifier>PMID: 26138125</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anesthesia, General - adverse effects ; Anesthesia, General - mortality ; Anesthesia, General - trends ; Cohort Studies ; Disease Management ; Early Medical Intervention - trends ; Endovascular Procedures - adverse effects ; Endovascular Procedures - mortality ; Endovascular Procedures - trends ; Female ; Humans ; Male ; Middle Aged ; Patient Safety ; Stroke - diagnosis ; Stroke - mortality ; Stroke - surgery ; Treatment Outcome ; Young Adult</subject><ispartof>Stroke (1970), 2015-08, Vol.46 (8), p.2142-2148</ispartof><rights>2015 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4021-2ffcdc2dd85b6092558071008503410531adfaa9bb1ba867f3aa1f93d9dbb7913</citedby><cites>FETCH-LOGICAL-c4021-2ffcdc2dd85b6092558071008503410531adfaa9bb1ba867f3aa1f93d9dbb7913</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26138125$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Abou-Chebl, Alex</creatorcontrib><creatorcontrib>Yeatts, Sharon D</creatorcontrib><creatorcontrib>Yan, Bernard</creatorcontrib><creatorcontrib>Cockroft, Kevin</creatorcontrib><creatorcontrib>Goyal, Mayank</creatorcontrib><creatorcontrib>Jovin, Tudor</creatorcontrib><creatorcontrib>Khatri, Pooja</creatorcontrib><creatorcontrib>Meyers, Phillip</creatorcontrib><creatorcontrib>Spilker, Judith</creatorcontrib><creatorcontrib>Sugg, Rebecca</creatorcontrib><creatorcontrib>Wartenberg, Katja E</creatorcontrib><creatorcontrib>Tomsick, Tom</creatorcontrib><creatorcontrib>Broderick, Joe</creatorcontrib><creatorcontrib>Hill, Michael D</creatorcontrib><title>Impact of General Anesthesia on Safety and Outcomes in the Endovascular Arm of Interventional Management of Stroke (IMS) III Trial</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>BACKGROUND AND PURPOSE—General anesthesia (GA) for endovascular therapy (EVT) of acute ischemic stroke may be associated with worse outcomes.
METHODS—The Interventional Management of Stroke III trial randomized patients within 3 hours of acute ischemic stroke onset to intravenous tissue-type plasminogen activator±EVT. GA use within 7 hours of stroke onset was recorded per protocol. Good outcome was defined as 90-day modified Rankin Scale ≤2. A multivariable analysis adjusting for dichotomized National Institutes of Health Stroke Scale (NIHSS; 8–19 versus ≥20), age, and time from onset to groin puncture was performed.
RESULTS—Four hundred thirty-four patients were randomized to EVT, 269 (62%) were treated under local anesthesia and 147 (33.9%) under GA; 18 (4%) were undetermined. The 2 groups were comparable except for median baseline NIHSS (16 local anesthesia versus 18 GA; P<0.0001). The GA group was less likely to achieve a good outcome (adjusted relative risk, 0.68; confidence interval, 0.52–0.90; P=0.0056) and had increased in-hospital mortality (adjusted relative risk, 2.84; confidence interval, 1.65–4.91; P=0.0002). Those with medically indicated GA had worse outcomes (adjusted relative risk, 0.49; confidence interval, 0.30–0.81; P=0.005) and increased mortality (relative risk, 3.93; confidence interval, 2.18–7.10; P<0.0001) with a trend for higher mortality with routine GA. There was no significant difference in the adjusted risks of subarachnoid hemorrhage (P=0.32) or symptomatic intracerebral hemorrhage (P=0.37).
CONCLUSIONS—GA was associated with worse neurological outcomes and increased mortality in the EVT arm; this was primarily true among patients with medical indications for GA. Relative risk estimates, though not statistically significant, suggest reduced risk for subarachnoid hemorrhage and symptomatic intracerebral hemorrhage under local anesthesia. Although the reasons for these associations are not clear, these data support the use of local anesthesia when possible during EVT.
CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT00359424.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia, General - adverse effects</subject><subject>Anesthesia, General - mortality</subject><subject>Anesthesia, General - trends</subject><subject>Cohort Studies</subject><subject>Disease Management</subject><subject>Early Medical Intervention - trends</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - mortality</subject><subject>Endovascular Procedures - trends</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patient Safety</subject><subject>Stroke - diagnosis</subject><subject>Stroke - mortality</subject><subject>Stroke - surgery</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMFu1DAQhi0EokvhDRDysRxSPE6cxMeoWtqIViuxyzmaxDYb6tiLnbTqlSfHqy09crJ--ZtvND8hH4FdApTwZbv7vvm2bm6aFMUlY3VVwiuyAsGLrCh5_ZqsGMtlxgspz8i7GH8xxnhei7fkjJeQ18DFivxppwMOM_WGXmunA1raOB3nvY4jUu_oFo2enyg6RTfLPPhJRzo6mgC6dso_YBwWi4E2YTpKWjfr8KDdPHqXXHfo8KeeUj5-bufg7zW9aO-2n2nbtnQXRrTvyRuDNuoPz-85-fF1vbu6yW431-1Vc5sNBeOQcWMGNXClatGXTHIhalZBuluwvAAmckBlEGXfQ491WZkcEYzMlVR9X0nIz8nFyXsI_veSbuymMQ7aWnTaL7GDirHkqSRPaHFCh-BjDNp0hzBOGJ46YN2x_e6l_RRFd2o_jX163rD0k1YvQ__qTkB9Ah69TT3Fe7s86tDtNdp5_3_3X4Pikqs</recordid><startdate>201508</startdate><enddate>201508</enddate><creator>Abou-Chebl, Alex</creator><creator>Yeatts, Sharon D</creator><creator>Yan, Bernard</creator><creator>Cockroft, Kevin</creator><creator>Goyal, Mayank</creator><creator>Jovin, Tudor</creator><creator>Khatri, Pooja</creator><creator>Meyers, Phillip</creator><creator>Spilker, Judith</creator><creator>Sugg, Rebecca</creator><creator>Wartenberg, Katja E</creator><creator>Tomsick, Tom</creator><creator>Broderick, Joe</creator><creator>Hill, Michael D</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201508</creationdate><title>Impact of General Anesthesia on Safety and Outcomes in the Endovascular Arm of Interventional Management of Stroke (IMS) III Trial</title><author>Abou-Chebl, Alex ; Yeatts, Sharon D ; Yan, Bernard ; Cockroft, Kevin ; Goyal, Mayank ; Jovin, Tudor ; Khatri, Pooja ; Meyers, Phillip ; Spilker, Judith ; Sugg, Rebecca ; Wartenberg, Katja E ; Tomsick, Tom ; Broderick, Joe ; Hill, Michael D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4021-2ffcdc2dd85b6092558071008503410531adfaa9bb1ba867f3aa1f93d9dbb7913</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia, General - adverse effects</topic><topic>Anesthesia, General - mortality</topic><topic>Anesthesia, General - trends</topic><topic>Cohort Studies</topic><topic>Disease Management</topic><topic>Early Medical Intervention - trends</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - mortality</topic><topic>Endovascular Procedures - trends</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patient Safety</topic><topic>Stroke - diagnosis</topic><topic>Stroke - mortality</topic><topic>Stroke - surgery</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abou-Chebl, Alex</creatorcontrib><creatorcontrib>Yeatts, Sharon D</creatorcontrib><creatorcontrib>Yan, Bernard</creatorcontrib><creatorcontrib>Cockroft, Kevin</creatorcontrib><creatorcontrib>Goyal, Mayank</creatorcontrib><creatorcontrib>Jovin, Tudor</creatorcontrib><creatorcontrib>Khatri, Pooja</creatorcontrib><creatorcontrib>Meyers, Phillip</creatorcontrib><creatorcontrib>Spilker, Judith</creatorcontrib><creatorcontrib>Sugg, Rebecca</creatorcontrib><creatorcontrib>Wartenberg, Katja E</creatorcontrib><creatorcontrib>Tomsick, Tom</creatorcontrib><creatorcontrib>Broderick, Joe</creatorcontrib><creatorcontrib>Hill, Michael D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abou-Chebl, Alex</au><au>Yeatts, Sharon D</au><au>Yan, Bernard</au><au>Cockroft, Kevin</au><au>Goyal, Mayank</au><au>Jovin, Tudor</au><au>Khatri, Pooja</au><au>Meyers, Phillip</au><au>Spilker, Judith</au><au>Sugg, Rebecca</au><au>Wartenberg, Katja E</au><au>Tomsick, Tom</au><au>Broderick, Joe</au><au>Hill, Michael D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of General Anesthesia on Safety and Outcomes in the Endovascular Arm of Interventional Management of Stroke (IMS) III Trial</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2015-08</date><risdate>2015</risdate><volume>46</volume><issue>8</issue><spage>2142</spage><epage>2148</epage><pages>2142-2148</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><abstract>BACKGROUND AND PURPOSE—General anesthesia (GA) for endovascular therapy (EVT) of acute ischemic stroke may be associated with worse outcomes.
METHODS—The Interventional Management of Stroke III trial randomized patients within 3 hours of acute ischemic stroke onset to intravenous tissue-type plasminogen activator±EVT. GA use within 7 hours of stroke onset was recorded per protocol. Good outcome was defined as 90-day modified Rankin Scale ≤2. A multivariable analysis adjusting for dichotomized National Institutes of Health Stroke Scale (NIHSS; 8–19 versus ≥20), age, and time from onset to groin puncture was performed.
RESULTS—Four hundred thirty-four patients were randomized to EVT, 269 (62%) were treated under local anesthesia and 147 (33.9%) under GA; 18 (4%) were undetermined. The 2 groups were comparable except for median baseline NIHSS (16 local anesthesia versus 18 GA; P<0.0001). The GA group was less likely to achieve a good outcome (adjusted relative risk, 0.68; confidence interval, 0.52–0.90; P=0.0056) and had increased in-hospital mortality (adjusted relative risk, 2.84; confidence interval, 1.65–4.91; P=0.0002). Those with medically indicated GA had worse outcomes (adjusted relative risk, 0.49; confidence interval, 0.30–0.81; P=0.005) and increased mortality (relative risk, 3.93; confidence interval, 2.18–7.10; P<0.0001) with a trend for higher mortality with routine GA. There was no significant difference in the adjusted risks of subarachnoid hemorrhage (P=0.32) or symptomatic intracerebral hemorrhage (P=0.37).
CONCLUSIONS—GA was associated with worse neurological outcomes and increased mortality in the EVT arm; this was primarily true among patients with medical indications for GA. Relative risk estimates, though not statistically significant, suggest reduced risk for subarachnoid hemorrhage and symptomatic intracerebral hemorrhage under local anesthesia. Although the reasons for these associations are not clear, these data support the use of local anesthesia when possible during EVT.
CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT00359424.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>26138125</pmid><doi>10.1161/STROKEAHA.115.008761</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0039-2499 |
| ispartof | Stroke (1970), 2015-08, Vol.46 (8), p.2142-2148 |
| issn | 0039-2499 1524-4628 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1700105792 |
| source | MEDLINE; American Heart Association Journals; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Aged Aged, 80 and over Anesthesia, General - adverse effects Anesthesia, General - mortality Anesthesia, General - trends Cohort Studies Disease Management Early Medical Intervention - trends Endovascular Procedures - adverse effects Endovascular Procedures - mortality Endovascular Procedures - trends Female Humans Male Middle Aged Patient Safety Stroke - diagnosis Stroke - mortality Stroke - surgery Treatment Outcome Young Adult |
| title | Impact of General Anesthesia on Safety and Outcomes in the Endovascular Arm of Interventional Management of Stroke (IMS) III Trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-27T09%3A06%3A27IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Impact%20of%20General%20Anesthesia%20on%20Safety%20and%20Outcomes%20in%20the%20Endovascular%20Arm%20of%20Interventional%20Management%20of%20Stroke%20(IMS)%20III%20Trial&rft.jtitle=Stroke%20(1970)&rft.au=Abou-Chebl,%20Alex&rft.date=2015-08&rft.volume=46&rft.issue=8&rft.spage=2142&rft.epage=2148&rft.pages=2142-2148&rft.issn=0039-2499&rft.eissn=1524-4628&rft_id=info:doi/10.1161/STROKEAHA.115.008761&rft_dat=%3Cproquest_cross%3E1700105792%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1700105792&rft_id=info:pmid/26138125&rfr_iscdi=true |