Scientific article

Endovascular treatment for acute ischemic stroke with or without general anesthesia: a matched comparison

Published inStroke, vol. 53, no. 5, p. 1520-1529
Publication date2022-05
First online date2022-03-28

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 score3), National Institutes of Health Stroke Scale after 24 hours, symptomatic intracranial hemorrhage with4 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.

  • Anesthesia, general
  • Intracranial hemorrhage
  • Ischemic stroke
  • Propensity score
  • Registries
  • Anesthesia, General / adverse effects
  • Brain Ischemia / etiology
  • Brain Ischemia / surgery
  • Endovascular Procedures / adverse effects
  • Humans
  • Intracranial Hemorrhages / etiology
  • Ischemic Stroke
  • Stroke / etiology
  • Stroke / surgery
  • Treatment Outcome
  • United States
Citation (ISO format)
WAGNER, Benjamin et al. Endovascular treatment for acute ischemic stroke with or without general anesthesia: a matched comparison. In: Stroke, 2022, vol. 53, n° 5, p. 1520–1529. doi: 10.1161/STROKEAHA.121.034934
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Article (Published version)
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ISSN of the journal0039-2499

Technical informations

Creation08/06/2022 7:25:00 AM
First validation08/06/2022 7:25:00 AM
Update time03/16/2023 7:57:19 AM
Status update03/16/2023 7:57:15 AM
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