• Stroke · Jun 2017

    Randomized Controlled Trial Comparative Study

    General Anesthesia Versus Conscious Sedation for Endovascular Treatment of Acute Ischemic Stroke: The AnStroke Trial (Anesthesia During Stroke).

    • Löwhagen Hendén Pia P From the Department of Anesthesiology and Intensive Care Medicine (P.L.H., H.S., S.-E.R.), Department of Radiology (A.R., B.L., D.D., K.S., G.W., M., Alexandros Rentzos, Jan-Erik Karlsson, Lars Rosengren, Birgitta Leiram, Henrik Sundeman, Dennis Dunker, Kunigunde Schnabel, Gunnar Wikholm, Mikael Hellström, and Sven-Erik Ricksten.
    • From the Department of Anesthesiology and Intensive Care Medicine (P.L.H., H.S., S.-E.R.), Department of Radiology (A.R., B.L., D.D., K.S., G.W., M.H.), and Department of Neurology (J.-E.K., L.R.), Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden.
    • Stroke. 2017 Jun 1; 48 (6): 1601-1607.

    Background And PurposeRetrospective studies have found that patients receiving general anesthesia for endovascular treatment in acute ischemic stroke have worse neurological outcome compared with patients receiving conscious sedation. In this prospective randomized single-center study, we investigated the impact of anesthesia technique on neurological outcome in acute ischemic stroke patients.MethodsNinety patients receiving endovascular treatment for acute ischemic stroke in 2013 to 2016 were included and randomized to general anesthesia or conscious sedation. Difference in neurological outcome at 3 months, measured as modified Rankin Scale score, was analyzed (primary outcome) and early neurological improvement of National Institutes of Health Stroke Scale and cerebral infarction volume. Age, sex, comorbidities, admission National Institutes of Health Stroke Scale score, intraprocedural blood pressure, blood glucose, Paco2 and Pco2 modified Thrombolysis in Cerebral Ischemia score, and relevant time intervals were recorded.ResultsIn the general anesthesia group 19 of 45 patients (42.2%) and in the conscious sedation group 18 of 45 patients (40.0%) achieved a modified Rankin Scale score ≤2 (P=1.00) at 3 months, with no differences in intraoperative blood pressure decline from baseline (P=0.57); blood glucose (P=0.94); PaCO2 (P=0.68); time intervals (P=0.78); degree of successful recanalization, 91.1% versus 88.9% (P=1.00); National Institutes of Health Stroke Scale score at 24 hours 8 (3-5) versus 9 (2-15; P=0.60); infarction volume, 20 (10-100) versus 20(10-54) mL (P=0.53); and hospital mortality (13.3% in both groups; P=1.00).ConclusionsIn endovascular treatment for acute ischemic stroke, no difference was found between general anesthesia and conscious sedation in neurological outcome 3 months after stroke.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT01872884.© 2017 American Heart Association, Inc.

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