GA vs. CS for Endovascular Stroke Therapy

Summary

After a stroke caused by a blockage (clot) in a blood vessel in the brain, patients may have the clot removed by threading a catheter from the groin up to the affected area of the brain. An anesthesiologist is involved in the patient's care during this procedure to maximize patient safety and procedural efficiency. The options for anesthesia for this procedure are general anesthesia (where the patient is unconscious) or sedation (where the patient is in a relaxed, calm, sleepy condition). Currently, it is unclear which of these anesthetic options contributes to the best patient outcome. The investigators would like to investigate whether or not one method of anesthesia (general or sedation) is better to use than the other when removing the clot.

Timeline

Start

2017-08-31

Primary completion

2019-08-01

Completion

2019-08-01

Publications

• Background Avitsian R, Machado SB. Anesthesia for Endovascular Approaches to Acute Ischemic Stroke. Anesthesiol Clin. 2016 Sep;34(3):497-509. doi: 10.1016/j.anclin.2016.04.004.
• Background Brinjikji W, Murad MH, Rabinstein AA, Cloft HJ, Lanzino G, Kallmes DF. Conscious sedation versus general anesthesia during endovascular acute ischemic stroke treatment: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2015 Mar;36(3):525-9. doi: 10.3174/ajnr.A4159. Epub 2014 Nov 13.
• Background Dhakal LP, Diaz-Gomez JL, Freeman WD. Role of anesthesia for endovascular treatment of ischemic stroke: do we need neurophysiological monitoring? Stroke. 2015 Jun;46(6):1748-54. doi: 10.1161/STROKEAHA.115.008223. Epub 2015 May 7. No abstract available.
• Background Davis MJ, Menon BK, Baghirzada LB, Campos-Herrera CR, Goyal M, Hill MD, Archer DP; Calgary Stroke Program. Anesthetic management and outcome in patients during endovascular therapy for acute stroke. Anesthesiology. 2012 Feb;116(2):396-405. doi: 10.1097/ALN.0b013e318242a5d2.
• Background Talke PO, Sharma D, Heyer EJ, Bergese SD, Blackham KA, Stevens RD. Republished: Society for Neuroscience in Anesthesiology and Critical Care expert consensus statement: Anesthetic management of endovascular treatment for acute ischemic stroke. Stroke. 2014 Aug;45(8):e138-50. doi: 10.1161/STROKEAHA.113.003412.
• Background Janssen H, Buchholz G, Killer M, Ertl L, Bruckmann H, Lutz J. General Anesthesia Versus Conscious Sedation in Acute Stroke Treatment: The Importance of Head Immobilization. Cardiovasc Intervent Radiol. 2016 Sep;39(9):1239-44. doi: 10.1007/s00270-016-1411-5. Epub 2016 Jul 7.
• Background Sivasankar C, Stiefel M, Miano TA, Kositratna G, Yandrawatthana S, Hurst R, Kofke WA. Anesthetic variation and potential impact of anesthetics used during endovascular management of acute ischemic stroke. J Neurointerv Surg. 2016 Nov;8(11):1101-1106. doi: 10.1136/neurintsurg-2015-011998. Epub 2015 Nov 27.
• Tosello R, Riera R, Tosello G, Clezar CN, Amorim JE, Vasconcelos V, Joao BB, Flumignan RL. Type of anaesthesia for acute ischaemic stroke endovascular treatment. Cochrane Database Syst Rev. 2022 Jul 20;7(7):CD013690. doi: 10.1002/14651858.CD013690.pub2.

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