Outcomes After Endovascular Therapy With Procedural Sedation vs General Anesthesia in Patients With Acute Ischemic Stroke : The AMETIS Randomized Clinical Trial

Medientyp: E-Artikel
Titel: Outcomes After Endovascular Therapy With Procedural Sedation vs General Anesthesia in Patients With Acute Ischemic Stroke : The AMETIS Randomized Clinical Trial : The AMETIS Randomized Clinical Trial
Beteiligte: Chabanne, Russell; Geeraerts, Thomas; Begard, Marc; Balança, Baptiste; Rapido, Francesca; Degos, Vincent; Tavernier, Benoit; Molliex, Serge; Velly, Lionel; Verdonk, Franck; Lukaszewicz, Anne-Claire; Perrigault, Pierre-François; Albucher, Jean-François; Cognard, Christophe; Guyot, Adrien; Fernandez, Charlotte; Masgrau, Aurélie; Moreno, Ricardo; Ferrier, Anna; Jaber, Samir; Bazin, Jean-Etienne; Pereira, Bruno; Futier, Emmanuel; Lagarde, Kevin; [...]
Erschienen: American Medical Association (AMA), 2023
Erschienen in: JAMA Neurology
Sprache: Englisch
DOI: 10.1001/jamaneurol.2023.0413
ISSN: 2168-6149
Entstehung:
Anmerkungen:
Beschreibung: <jats:sec><jats:title>Importance</jats:title><jats:p>General anesthesia and procedural sedation are common practice for mechanical thrombectomy in acute ischemic stroke. However, risks and benefits of each strategy are unclear.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To determine whether general anesthesia or procedural sedation for anterior circulation large-vessel occlusion acute ischemic stroke thrombectomy are associated with a difference in periprocedural complications and 3-month functional outcome.</jats:p></jats:sec><jats:sec><jats:title>Design, Setting, and Participants</jats:title><jats:p>This open-label, blinded end point randomized clinical trial was conducted between August 2017 and February 2020, with final follow-up in May 2020, at 10 centers in France.</jats:p><jats:p>Adults with occlusion of the intracranial internal carotid artery and/or the proximal middle cerebral artery treated with thrombectomy were enrolled.</jats:p></jats:sec><jats:sec><jats:title>Interventions</jats:title><jats:p>Patients were assigned to receive general anesthesia with tracheal intubation (n = 135) or procedural sedation (n = 138).</jats:p></jats:sec><jats:sec><jats:title>Main Outcomes and Measures</jats:title><jats:p>The prespecified primary composite outcome was functional independence (a score of 0 to 2 on the modified Rankin Scale, which ranges from 0 [no neurologic disability] to 6 [death]) at 90 days and absence of major periprocedural complications (procedure-related serious adverse events, pneumonia, myocardial infarction, cardiogenic acute pulmonary edema, or malignant stroke) at 7 days.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among 273 patients evaluable for the primary outcome in the modified intention-to-treat population, 142 (52.0%) were women, and the mean (SD) age was 71.6 (13.8) years. The primary outcome occurred in 38 of 135 patients (28.2%) assigned to general anesthesia and in 50 of 138 patients (36.2%) assigned to procedural sedation (absolute difference, 8.1 percentage points; 95% CI, −2.3 to 19.1; <jats:italic>P</jats:italic> = .15). At 90 days, the rate of patients achieving functional independence was 33.3% (45 of 135) with general anesthesia and 39.1% (54 of 138) with procedural sedation (relative risk, 1.18; 95% CI, 0.86-1.61; <jats:italic>P</jats:italic> = .32). The rate of patients without major periprocedural complications at 7 days was 65.9% (89 of 135) with general anesthesia and 67.4% (93 of 138) with procedural sedation (relative risk, 1.02; 95% CI, 0.86-1.21; <jats:italic>P</jats:italic> = .80).</jats:p></jats:sec><jats:sec><jats:title>Conclusions and Relevance</jats:title><jats:p>In patients treated with mechanical thrombectomy for anterior circulation acute ischemic stroke, general anesthesia and procedural sedation were associated with similar rates of functional independence and major periprocedural complications.</jats:p></jats:sec><jats:sec><jats:title>Trial Registration</jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT03229148">NCT03229148</jats:ext-link></jats:p></jats:sec>

Nur in Feld suchen:

Zuletzt gesuchte Begriffe: