| Conscious sedation versus general anesthesia during endovascular therapy for acute anterior circulation stroke: preliminary results from a retrospective, multicenter study. | |
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MedLine Citation:
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PMID: 20395617 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Patients undergoing intra-arterial therapy (IAT) for acute ischemic stroke receive either general anesthesia (GA) or conscious sedation. GA may delay time to treatment, whereas conscious sedation may result in patient movement and compromise the safety of the procedure. We sought to determine whether there were differences in safety and outcomes in GA patients before initiation of IAT. METHODS: A cohort of 980 patients at 12 stroke centers underwent IAT for acute stroke between 2005 and 2009. Only patients with anterior circulation strokes due to large-vessel occlusion were included in the study. A binary logistic-regression model was used to determine independent predictors of good outcome and death. RESULTS: The mean age was 66+/-15 years and median National Institutes of Health Stroke Scale score was 17 (interquartile range, 13-20). The overall recanalization rate was 68% and the symptomatic hemorrhage rate was 9.2%. GA was used in 44% of patients with no differences in intracranial hemorrhage rates when compared with the conscious sedation group. The use of GA was associated with poorer neurologic outcome at 90 days (odds ratio=2.33; 95% CI, 1.63-3.44; P<0.0001) and higher mortality (odds ratio=1.68; 95% CI, 1.23-2.30; P<0.0001) compared with conscious sedation. CONCLUSIONS: Patients placed under GA during IAT for anterior circulation stroke appear to have a higher chance of poor neurologic outcome and mortality. There do not appear to be differences in hemorrhagic complications between the 2 groups. Future clinical trials with IAT can help elucidate the etiology of the differences in outcomes. |
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Authors:
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Alex Abou-Chebl; Ridwan Lin; Muhammad Shazam Hussain; Tudor G Jovin; Elad I Levy; David S Liebeskind; Albert J Yoo; Daniel P Hsu; Marilyn M Rymer; Ashis H Tayal; Osama O Zaidat; Sabareesh K Natarajan; Raul G Nogueira; Ashish Nanda; Melissa Tian; Qing Hao; Junaid S Kalia; Thanh N Nguyen; Michael Chen; Rishi Gupta |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural Date: 2010-04-15 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 41 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-05-25 Completed Date: 2010-06-11 Revised Date: 2010-10-01 |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 1175-9 Citation Subset: IM |
Affiliation:
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Department of Neurology, Vanderbilt Stroke Center, A-0118 Medical Center North, Nashville, TN 37232-2551, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Anesthesia, General* Brain Ischemia / pathology*, therapy* Cohort Studies Conscious Sedation* Disease-Free Survival Female Humans Logistic Models Male Middle Aged Retrospective Studies Stroke / mortality*, therapy* Survival Rate |
| Comments/Corrections | |
Comment In:
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Stroke. 2010 Oct;41(10):e573; author reply e574-5
[PMID:
20814004
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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