Neurointervention.  2019 Mar;14(1):17-26. 10.5469/neuroint.2019.00045.

Influence of Anesthesia Type on Outcomes after Endovascular Treatment in Acute Ischemic Stroke: Meta-Analysis

• Kim C
• Kim SE
• Jeon JP

• KMID: 2446778
• DOI: http://doi.org/10.5469/neuroint.2019.00045

Abstract

PURPOSE
To assess clinical and angiographic outcomes after endovascular treatment (EVT) in ischemic stroke patients according to anesthesia types (general anesthesia vs. conscious sedation). MATERIALS AND METHODS: A systematic literature review through an online data base between January 1990 and September 2017 was performed. A fixed effect model was used in cases of <50% heterogeneity. The primary outcomes were good clinical outcome at the 3-month follow-up and successful recanalization. A meta-regression analysis was done to estimate primary outcomes of log odds ratio (OR) on onset-to-puncture time (OTP) differences. Publication bias was determined using Begg's funnel plot and additional the Trim and Fill method.
RESULTS
Sixteen articles including 2,662 patients (general anesthesia, n=1,275; conscious sedation, n=1,387) were included. General anesthesia significantly decreased good outcomes than conscious sedation (OR, 0.564; 95% confidence interval [CI], 0.354-0.899). However, outcomes did not differ significantly in randomized controlled trials (RCTs; OR, 1.101; 95% CI, 0.395-3.071). Anesthesia type was not associated with successful recanalization (OR, 0.985; 95% CI, 0.787-1.233). General anesthesia increased the risk of mortality (OR, 1.532; 95% CI, 1.187-1.976) and pneumonia (OR, 1.613; 95% CI, 1.172-2.221), but not symptomatic intracranial hemorrhage (OR, 1.125; 95% CI, 0.767-1.652). The meta-regression analysis showed no linear relationship between OTP differences and log OR of good outcome (coefficient, 0.0004; P=0.95) or successful recanalization (coefficient, 0.0005; P=0.94), respectively.
CONCLUSION
General anesthesia seemed to be associated with adverse clinical outcome after EVT. However, its efficacy was not demonstrated in RCTs. Successful recanalization did not differ according to anesthesia type. Studies using individual patient data based on further RCTs are necessary to elucidate anesthesia effect on procedural and clinical outcomes.

Keyword

Anesthesia, General; Stroke

MeSH Terms

Anesthesia*
Anesthesia, General
Conscious Sedation
Follow-Up Studies
Humans
Intracranial Hemorrhages
Methods
Mortality
Odds Ratio
Pneumonia
Population Characteristics
Publication Bias
Stroke*

Figure

• 

  Fig. 1. Flow diagram for identification of relevant studies.

• 

  Fig. 2. Comparisons of endovascular treatment outcomes according to anesthetic type: general anesthesia (GA) vs. continuous sedation (CS) regarding good functional 3-month outcome (A) and successful recanalization (B) in randomized controlled trials (RCT) or non-RCTs and all studies. OR, odds ratio; CI, confidence interval.

• 

  Fig. 3. Meta-regression of differences in onset to groin puncture time (OTP, also descried as the time to treatment) and log of odds ratio of good 3-month outcome (A) and successful recanalization (B) in studies included in this meta-analysis. The difference in the mean or median time OTP was used in five or six studies. Each study is represented by a circle, whose size is proportional to that study’s weight in the meta-analysis. The straight line represents the best line of correlation (P=0.95 in A and P=0.94 in B).

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