Thrombectomy Outcomes With General vs Nongeneral Anesthesia: A Pooled Patient-Level Analysis From the EXTEND-IA Trials and SELECT Study

Authors

Amrou Sarraj
Gregory W Albers
Peter J Mitchell
Ameer E Hassan
Michael G Abraham
Spiros Blackburn
Gagan Sharma
Nawaf Yassi
Timothy J Kleinig
Darshan G Shah
Teddy Y Wu
Muhammad Shazam Hussain
Wondwoseen G Tekle
Santiago Ortega Gutierrez
Amin Nima Aghaebrahim
Diogo C Haussen
Gabor Toth
Deep Pujara
Ronald F Budzik
William Hicks
Nirav Vora
Randall C Edgell
Sabreena Slavin
Colleen G Lechtenberg
Laith Maali
Abid Qureshi
Lee Rosterman
Mohammad Ammar Abdulrazzak
Tareq AlMaghrabi
Faris Shaker
Osman Mir
Ashish Arora
Sheryl Martin-Schild
Clark W Sitton
Leonid Churilov
Rishi Gupta
Maarten G Lansberg
Raul G Nogueira
James C Grotta
Geoffrey Alan Donnan
Stephen M Davis
Bruce C V Campbell

Publication Date

1-17-2023

Journal

Neurology

Abstract

BACKGROUND AND OBJECTIVES: The effect of anesthesia choice on endovascular thrombectomy (EVT) outcomes is unclear. Collateral status on perfusion imaging may help identify the optimal anesthesia choice.

METHODS: In a pooled patient-level analysis of EXTEND-IA, EXTEND-IA TNK, EXTEND-IA TNK part II, and SELECT, EVT functional outcomes (modified Rankin Scale score distribution) were compared between general anesthesia (GA) vs non-GA in a propensity-matched sample. Furthermore, we evaluated the association of collateral flow on perfusion imaging, assessed by hypoperfusion intensity ratio (HIR) - Tmax > 10 seconds/Tmax > 6 seconds (good collaterals - HIR < 0.4, poor collaterals - HIR ≥ 0.4) on the association between anesthesia type and EVT outcomes.

RESULTS: Of 725 treated with EVT, 299 (41%) received GA and 426 (59%) non-GA. The baseline characteristics differed in presentation National Institutes of Health Stroke Scale score (median [interquartile range] GA: 18 [13-22], non-GA: 16 [11-20],

DISCUSSION: GA was associated with worse functional outcomes after EVT, particularly in patients with poor collaterals in a propensity score-matched analysis from a pooled patient-level cohort from 3 randomized trials and 1 prospective cohort study. The confounding by indication may persist despite the doubly robust nature of the analysis. These findings have implications for randomized trials of GA vs non-GA and may be of utility for clinicians when making anesthesia type choice.

CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that use of GA is associated with worse functional outcome in patients undergoing EVT.

TRIAL REGISTRATION INFORMATION: EXTEND-IA: ClinicalTrials.gov (NCT01492725); EXTEND-IA TNK: ClinicalTrials.gov (NCT02388061); EXTEND-IA TNK part II: ClinicalTrials.gov (NCT03340493); and SELECT: ClinicalTrials.gov (NCT02446587).

Keywords

Humans, Anesthesia, General, Prospective Studies, Thrombectomy, Treatment Outcome, Randomized Controlled Trials as Topic