Acute Ischemic Stroke
Conditions
Keywords
Acute Ischemic Stroke, Mechanical Thrombectomy, General Anesthesia, Sedoanalgesia
Brief summary
This retrospective cohort study examined clinical outcomes in patients who underwent mechanical thrombectomy for acute ischemic stroke under general anesthesia or sedoanalgesia. Patient data from 2014 to 2018 were obtained from hospital medical records. Mortality and neurological outcomes were compared between anesthesia groups.
Detailed description
This retrospective observational cohort study was conducted at the University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital. Medical records of patients who underwent mechanical thrombectomy for acute ischemic stroke between 2014 and 2018 were reviewed. Patients who received mechanical thrombectomy within 6 hours of symptom onset and achieved a Thrombolysis in Cerebral Infarction (TICI) reperfusion grade of 2a, 2b, or 3 were included. Patients with TICI grades of 0 or 1, those younger than 18 years, patients with an APACHE II score ≥25, a Glasgow Coma Scale score \<10, those requiring endotracheal intubation before the procedure, or patients discharged from the procedure intubated to the intensive care unit were excluded. Based on anesthesia records, patients were classified into two cohorts: those who underwent the procedure under general anesthesia and those managed with sedoanalgesia. No assignment to anesthesia technique was performed as part of the study, and anesthesia management was determined according to routine clinical practice. Demographic characteristics, medical history, radiological findings, procedural details, and perioperative variables were extracted from hospital records. Neurological status was assessed using the National Institutes of Health Stroke Scale (NIHSS) at 4 and 24 hours after the procedure, and functional outcome was evaluated using the modified Rankin Scale during hospitalization and at 3 months after thrombectomy. Intraoperative bispectral index (BIS) values and cerebral oxygenation measured by near-infrared spectroscopy (NIRS) were recorded when available. Safety outcomes including peri-procedural hemodynamic instability, vasopressor or antihypertensive use, need for pacing, and intensive care unit (ICU) length of stay will be evaluated. Neurological outcomes will be assessed longitudinally using NIHSS at baseline, 4 hours, 24 hours, and modified Rankin Scale (mRS/TICI) immediately after the procedure and at 3 months. The primary outcome of the study was all-cause mortality. Secondary outcomes included neurological and functional outcomes, perioperative variables, intensive care unit length of stay, and procedure-related complications. Comparisons between anesthesia cohorts were performed using routinely collected clinical data. Postoperative delirium occurring during the first 7 days after the procedure was evaluated as a secondary safety outcome when documented in the medical records
Interventions
OTHERGeneral Anesthesia
Patients who underwent mechanical thrombectomy under general anesthesia, based on anesthesia records.
OTHERSedoanalgesia
Patients who underwent mechanical thrombectomy under sedoanalgesia, based on anesthesia records.
Sponsors
Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital
Bakirkoy Dr. Sadi Konuk Research and Training Hospital
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* Age ≥18 years * Acute ischemic stroke due to large vessel occlusion (MCA M1) * Mechanical thrombectomy performed within 6 hours of symptom onset * Pre-procedural TICI score 0-1
Exclusion criteria
* Age ≥100 years * APACHE II score of 25 or higher * Glasgow Coma Scale score below 10 * Requirement for endotracheal intubation before the procedure * Patients discharged from the procedure to the intensive care unit while intubated * Time from symptom onset to procedure exceeding 6 hours
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| All-Cause Mortality | During index hospitalization and at 3 months post-procedure | Comparison of all-cause mortality between patients undergoing mechanical thrombectomy under general anesthesia and sedoanalgesia. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| NIHSS Score | Baseline, 4 hours, 24 hours post-procedure | The National Institutes of Health Stroke Scale (NIHSS) is used to quantify stroke severity (score range 0-42; higher scores indicate more severe stroke) |
| Modified Rankin Scale (mRS) | Immediately after completion of the angiographic procedure and at 3 months after the initial thrombectomy | The modified Rankin Scale (mRS) is a global functional outcome measure used after stroke to categorize the level of functional independence. |
| TICI Reperfusion Grade | Immediately after completion of the angiographic procedure and at 3 months after the initial thrombectomy. | The Thrombolysis in Cerebral Infarction (TICI) grading system is used after endovascular revascularization to describe angiographic reperfusion (e.g., 0-3; higher grades indicate better reperfusion) |
| Near-Infrared Spectroscopy (NIRS) Values | During index hospitalization and at 3 months post-procedure | Regional cerebral oxygen saturation was monitored using near-infrared spectroscopy (NIRS) during the procedure and throughout the early postoperative period. |
| Bispectral Index (BIS) Values | During the procedure | Depth of anesthesia was monitored using bispectral index (BIS) values recorded during the procedure. |
| Procedure Duration | During the procedure | Total duration of the mechanical thrombectomy procedure. |
| Time From Symptom Onset to Procedure | At the time of the procedure | Elapsed time between symptom onset and initiation of mechanical thrombectomy. |
| ICU Length of Stay | Through study completion, an average of 3 months | Duration of stay in the intensive care unit following the procedure |
| Hemodynamic Parameters | From procedure until 3 months post-procedure | Systolic and diastolic blood pressure values recorded during the perioperative period |
| Procedure-Related Complications | During hospitalization | Occurrence of neurological or procedure-related complications during hospitalization |
| Postoperative delirium | Within 30 days after procedure | Incidence of postoperative delirium during the first 3 postoperative months |
| Postoperative demans | Within 30 days after procedure | Incidence of postoperative delirium during the first 3 postoperative months |
Countries
Turkey (Türkiye)
Contacts
CONTACTFatma Acil, M.D.
CONTACTBedih Balkan, Assoc.Prof.
Outcome results
None listed