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Research ArticleNeurointervention

Impact of Anesthesia on the Outcome of Acute Ischemic Stroke after Endovascular Treatment with the Solitaire Stent Retriever

A. Slezak, R. Kurmann, L. Oppliger, A. Broeg-Morvay, J. Gralla, G. Schroth, H.P. Mattle, M. Arnold, U. Fischer, S. Jung, R. Greif, F. Neff, P. Mordasini and M.-L. Mono
American Journal of Neuroradiology July 2017, 38 (7) 1362-1367; DOI: https://doi.org/10.3174/ajnr.A5183
A. Slezak
aFrom the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
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  • ORCID record for A. Slezak
R. Kurmann
aFrom the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
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L. Oppliger
aFrom the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
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A. Broeg-Morvay
aFrom the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
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J. Gralla
bDiagnostic and Interventional Neuroradiology (J.G., G.S., P.M.)
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G. Schroth
bDiagnostic and Interventional Neuroradiology (J.G., G.S., P.M.)
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H.P. Mattle
aFrom the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
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M. Arnold
aFrom the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
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U. Fischer
aFrom the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
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S. Jung
aFrom the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
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R. Greif
cAnesthesiology and Pain Medicine (R.G., F.N.), University Hospital Bern and University of Bern, Bern, Switzerland.
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F. Neff
cAnesthesiology and Pain Medicine (R.G., F.N.), University Hospital Bern and University of Bern, Bern, Switzerland.
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P. Mordasini
bDiagnostic and Interventional Neuroradiology (J.G., G.S., P.M.)
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M.-L. Mono
aFrom the Departments of Neurology (A.S., R.K., L.O., A.B.-M., H.P.M., M.A., U.F., S.J., M.-L.M.)
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    Figure.

    Three-month outcome of patients under GA compared with patients with CS. The figures in the bar indicate the percentage of patients with a given mRS at 3-month follow-up.

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    Table 1:

    Patient characteristics and procedural detailsa

    CSGAP Value
    No. of patients135266
    Age (yr) (mean) (SD)70.5 (14.9)70.9 (13.9).803
    Age older than 80 yr46 (34.1)76 (28.6).258
    Male sex59 (43.7)140 (52.6).091
    Prestroke mRS < 1124 (94.7)228 (89.8).104
    TOAST.162
        Large-artery disease26 (19.3)63 (23.8)
        Small-artery disease3 (2.2)6 (2.3)
        Cardioembolism64 (47.4)95 (35.8)
        Stroke of other determined etiology15 (11.1)23 (8.7)
        Stroke of undetermined etiology27 (20)78 (29.5)
    Atrial fibrillation39 (31.2)84 (36.5).164
    Hyperlipidemia59 (44.4)120 (45.8).786
    Arterial hypertension66 (48.9)146 (54.9).255
    Diabetes mellitus39 (29.3)74 (28.2).823
    Coronary disease21 (17.4)65 (27.3).037
    Smoking49 (38.9)111 (46.3).177
    Prior stroke or TIA15 (14.2)32 (14.4).949
    Recurrent stroke within 3 mo9 (7.8)11 (4.9).462
    NIHSS on admission (mean) (SD)13.1 (5.7)17.2 (6.6)<.001
    Vessel occlusion site<.001
        ICA20 (14.8)117 (44)
        ACA1 (0.7)0 (0)
        MCA114 (84.4)149 (56)
    Time from symptom onset to start of EVT (mean) (SD) (min)277 (126)299 (157).165
    Intravenous rtPA and EVT44 (32.6)78 (29.3).501
    Mechanical thrombectomy only72 (53.3)159 (59.8).217
    Maximal systolic blood pressure (mm Hg) (mean) (SD)177 (25)176 (25).631
    Minimal systolic blood pressure (mm Hg) (mean) (SD)149 (33)133 (42)<.001
    Systolic BP gradient during procedure (mm Hg) (mean) (SD)31 (26)50 (32)<.001
    BP-increasing drugs54 (40.3)254 (95.8)<.001
    BP-lowering drugs42 (31.1)104 (39.1).116
    TICI 2–3 recanalization116 (85.9)235 (88.3).488
    3-month mRS 0–137 (27.4)56 (21.2).154
    3-month mRS 0–264 (47.4)85 (32).002
    NIHSS after 24 hr (mean) (SD)9 (8.3)13.9 (11.2)<.001
    Death within 3 months28 (20.7)77 (28.9).077
    • Note:—ACA indicates anterior cerebral artery; BP, blood pressure.

    • ↵a Data are No. (%) unless otherwise indicated.

    • View popup
    Table 2:

    Peri- and postprocedural complications of endovascular treatment with the Solitaire stent retriever in anterior circulation strokea

    CSGAP Value
    Pneumonia22 (16.5)67 (25.3).048
    Symptomatic ICH (PROACT II)9 (6.8)20 (7.6).755
    Symptomatic ICH (ECASS II)9 (6.8)21 (8).658
    Systemic bleeding4 (3)3 (1.1).185
    Asymptomatic ICH (PROACT II)24 (18)52 (19.9).655
    Peri-interventional complications
        Dissection6 (4.5)12 (4.6).975
        Thrombus dislocation12 (9)33 (12.5).302
        Perforation of intracranial vessels2 (1.5)5 (1.9).773
    • Note:—ICH indicates intracerebral hemorrhage.

    • ↵a Data are No. (%) unless otherwise indicated.

    • View popup
    Table 3:

    Predictors of outcome at 3 months (multivariable logistic regression)

    Odds Ratio (95% CI)P Value
    GA0.873 (0.505–1.512).629
    Age0.95 (0.932–0.969)<.001
    NIHSS0.894 (0.855–0.933)<.001
    Time from symptom onset to start of EVT0.998 (0.996–0.999).01
    Symptomatic ICH0.109 (0.028–0.428).002
    Diabetes mellitus0.544 (0.305–0.972).04
    • Note:—ICH indicates intracerebral hemorrhage.

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American Journal of Neuroradiology: 38 (7)
American Journal of Neuroradiology
Vol. 38, Issue 7
1 Jul 2017
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A. Slezak, R. Kurmann, L. Oppliger, A. Broeg-Morvay, J. Gralla, G. Schroth, H.P. Mattle, M. Arnold, U. Fischer, S. Jung, R. Greif, F. Neff, P. Mordasini, M.-L. Mono
Impact of Anesthesia on the Outcome of Acute Ischemic Stroke after Endovascular Treatment with the Solitaire Stent Retriever
American Journal of Neuroradiology Jul 2017, 38 (7) 1362-1367; DOI: 10.3174/ajnr.A5183

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Impact of Anesthesia on the Outcome of Acute Ischemic Stroke after Endovascular Treatment with the Solitaire Stent Retriever
A. Slezak, R. Kurmann, L. Oppliger, A. Broeg-Morvay, J. Gralla, G. Schroth, H.P. Mattle, M. Arnold, U. Fischer, S. Jung, R. Greif, F. Neff, P. Mordasini, M.-L. Mono
American Journal of Neuroradiology Jul 2017, 38 (7) 1362-1367; DOI: 10.3174/ajnr.A5183
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