Endovascular Treatment for Acute Ischemic Stroke With or Without General Anesthesia: A Matched Comparison
Authors: Wagner Benjamin , Lorscheider Johannes , Wiencierz Andrea , Blackham Kristine , Psychogios Marios , Bolliger Daniel , De Marchis Gian Marco , Engelter Stefan T. , Lyrer Philippe , Wright Patrick R. , Fischer Urs , Mordasini Pasquale , Nannoni Stefania , Puccinelli Francesco , Kahles Timo , Bianco Giovanni , Carrera Emmanuel , Luft Andreas R. , Cereda Carlo W. , Kägi Georg , Weber Johannes , Nedeltchev Krassen , Michel Patrik , Gralla Jan , Arnold Marcel , Bonati Leo H. , Anon Javier , Clarke Sandra , Diepers Michael , Gruber Philipp , Martin Eileen , Remonda Luca , Schweikert Andreas , Zupa. Vedrana , Altersberger Valerian , Brehm Alex , Dittrich Tolga , El Mekabaty Amgad , Fladt Joachim , Fisch Urs , Gensicke Henrik , Hert Lisa , Manuzzi Sabrina , Maurer Marina , Meya Louisa , Peters Nils , Polymeris Alexandros , Thilemann Sebastian , Traenka Christopher , Tsogkas Ioannes , Zietz Anaelle , Goeldlin Martina , Heldner Mirjam , Jung Simon , Kaesmacher Johannes , Mamaari Basel , Meinel Thomas , Mueller Madlaine , Sarykaya Hakan , Seiffge David , Siepen Bernhard , Vynkier Jan , Eskandari Ashraf , Pantazou Vasiliki , Strambo Davide , Frangi Jane , Sihabdeen Shairin , Vehoff Jochen , Katan Mira , Mueller Achim , Wegener Susanne 
Published: March 2022

Background:

Endovascular treatment in large artery occlusion stroke reduces disability. However, the impact of anesthesia type on clinical outcomes remains uncertain.

Methods:

We compared consecutive patients in the Swiss Stroke Registry with anterior circulation stroke receiving endovascular treatment with or without general anesthesia (GA). The primary outcome was disability on the modified Rankin Scale after 3 months, analyzed with ordered logistic regression. Secondary outcomes included dependency or death (modified Rankin Scale score
≥
3), National Institutes of Health Stroke Scale after 24 hours, symptomatic intracranial hemorrhage with
≥
4 points worsening on National Institutes of Health Stroke Scale within 7 days, and mortality. Coarsened exact matching and propensity score matching were performed to adjust for indication bias.

Results:

One thousand two hundred eighty-four patients (GA: n=851, non-GA: n=433) from 8 Stroke Centers were included. Patients treated with GA had higher modified Rankin Scale scores after 3 months than patients treated without GA, in the unmatched (odds ratio [OR], 1.75 [1.42–2.16];
P
<0.001), the coarsened exact matching (n=332–524, using multiple imputations of missing values; OR, 1.60 [1.08–2.36];
P
=0.020), and the propensity score matching analysis (n=568; OR, 1.61 [1.20–2.15];
P
=0.001). In the coarsened exact matching analysis, there were no significant differences in National Institutes of Health Stroke Scale after 1 day (estimated coefficient 2.61 [0.59–4.64]), symptomatic intracranial hemorrhage (OR, 1.06 [0.30–3.75]), dependency or death (OR, 1.42 [0.91–2.23]), or mortality (OR, 1.65 [0.94–2.89]). In the propensity score matching analysis, National Institutes of Health Stroke Scale after 24 hours (estimated coefficient, 3.40 [1.76–5.04]), dependency or death (OR, 1.49 [1.07–2.07]), and mortality (OR, 1.65 [1.11–2.45]) were higher in the GA group, whereas symptomatic intracranial hemorrhage did not differ significantly (OR, 1.77 [0.73–4.29]).

Conclusions:

This large study showed worse functional outcome after endovascular treatment of anterior circulation stroke with GA than without GA in a real-world setting. This finding appears to be independent of known differences in patient characteristics between groups.