Abstract
BACKGROUND AND PURPOSE: Endovascular therapy for acute ischemic stroke is often performed with the patient under conscious sedation. Emergent conversion from conscious sedation to general anesthesia is sometimes necessary. The aim of this study was to assess the functional outcome in converted patients compared with patients who remained in conscious sedation and to identify predictors associated with the risk of conversion.
MATERIALS AND METHODS: Data from 368 patients, included in 3 trials randomizing between conscious sedation and general anesthesia before endovascular therapy (SIESTA, ANSTROKE, and GOLIATH) constituted the study cohort. Twenty-one (11%) of 185 patients randomized to conscious sedation were emergently converted to general anesthesia.
RESULTS: Absence of hyperlipidemia seemed to be the strongest predictor of conversion to general anesthesia, albeit a weak predictor (area under curve = 0.62). Sex, hypertension, diabetes, smoking status, atrial fibrillation, blood pressure, size of the infarct, and level and side of the occlusion were not significantly associated with conversion to general anesthesia. Neither age (mean age, 71.3 ± 13.8 years for conscious sedation versus 71.6 ± 12.3 years for converters, P = .58) nor severity of stroke (mean NIHSS score, 17 ± 4 versus 18 ± 4, respectively, P = .27) were significantly different between converters and those who tolerated conscious sedation. The converters had significantly worse outcome with a common odds ratio of 2.67 (P = .015) for a shift toward a higher mRS score compared with the patients remaining in the conscious sedation group.
CONCLUSIONS: Patients undergoing conversion had significantly worse outcome compared with patients remaining in conscious sedation. No factor was identified that predicted conversion from conscious sedation to general anesthesia.
ABBREVIATIONS:
- AUC
- area under the curve
- CS
- conscious sedation
- EVT
- endovascular therapy
- GA
- general anesthesia
- MABP
- mean arterial blood pressure
- SAGA
- SIESTA, ANSTROKE, and GOLIATH
Footnotes
C.Z. Simonsen, S. Schönenberger, and P.L. Hendén contributed equally to this work.
Disclosures: Claus Z. Simonsen—RELATED: Grant: Novo Nordisk Foundation.* Pia Löwhagen Hendén—UNRELATED: Employment: Sahlgrenska University Hospital, clinical work as an MD. Albert J. Yoo—UNRELATED: Consultancy: Cerenovus, Penumbra, Genentech; Grants/Grants Pending: Medtronic, Cerenovus, Penumbra, Stryker, Genentech*; Other: Insera Therapeutics, Comments: equity interest. Julian Bösel—UNRELATED: Grants/Grants Pending: Patient-Centered Outcomes Research Institute, Comments: participation in Patient-Centered Outcomes Research Institute, Award for SETPOINT2; Payment for Lectures Including Service on Speakers Bureaus: Medtronic, Boehringer Ingelheim, ZOLL Medical Corporation, Comments: speakers honoraria and travel support; Royalties: Thieme, Comments: book on neurocritical care, several book chapters; Travel/Accommodations/Meeting Expenses Unrelated to Activities Listed: Medtronic, Boehringer Ingelheim, ZOLL Medical Corporation. Mads Rasmussen—RELATED: Grant: Health Research Foundation of Central Denmark Region. *Money paid to the institution.
- © 2020 by American Journal of Neuroradiology