Anaesthetic management during intracranial mechanical thrombectomy: Systematic review and meta-analysis of current data

Guillaume Gravel, Grégoire Boulouis, Wagih Benhassen, Christine Rodriguez-Regent, Denis Trystram, Myriam Edjlali-Goujon, Jean François Meder, Catherine Oppenheim, Serge Bracard, Waleed Brinjikji, Olivier N. Naggara

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective Our aim was to compare the clinical outcome of patients with ischaemic stroke with anterior large vessel occlusion treated with stent retrievers and/or contact aspiration mechanical thrombectomy (MT) under general anaesthesia (GA) or conscious sedation non-GA through a systematic review and meta-analysis. Methods The literature was searched using PubMed, Embase and Cochrane databases to identify studies reporting on anaesthesia and MT. Using fixed or random weighted effect, we evaluated the following outcomes: 3-month mortality, modified Rankin Score (mRs) 0-2, recanalisation success (thrombolysis in cerebral infarction (TICI) ≥2b) and symptomatic intracerebral haemorrhagic (sICH) transformation. Results We identified seven cohorts (including three dedicated randomised controlled trials), totalling 1929 patients (932 with GA). Over the entire sample, mortality, mRs 0-2, TICI≥2b and sICH rates were, respectively 17.5% (99% CI 9.7% to 29.6%; Q-value: 60.1; I 2: 93%, 1717 patients), 42.1% (99% CI 33.3% to 51.7%; Q-value: 41.3; I 2: 87.9%), 82.9% (99% CI 74.0% to 89.1%; Q-value: 20.7; I 2: 80.6%, 1006 patients) and 5.5% (99% CI 2.8% to 10.8%; Q-value: 18.6; I 2: 78.5%). MT performed in non-GA patients was associated with better 3-month functional outcome (pooled OR, 1.35; 99% CI 1.04 to 1.76; Q-value: 24.0; I 2: 9.2%, 1845 patients) and lower 3-month mortality rate (pooled OR, 0.70; 99% CI 0.49 to 0.98; Q-value: 1.4; I 2: 0%, 1717 patients; fixed weighted effect model) compared with GA. MT performed under conscious sedation non-GA had significantly shorter onset-to-recanalisation and onset-to-groin delay compared with GA, and recanalisation success and sICH were similar. Conclusion Non-GA during MT for anterior acute ischaemic stroke with current-generation stent retriever/aspiration devices is associated with better 3-month functional outcome and lower mortality rates. These unadjusted estimates are subject to biases and should be interpreted with caution.

Original languageEnglish (US)
Pages (from-to)68-74
Number of pages7
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume90
Issue number1
DOIs
StatePublished - Jan 1 2019

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Thrombectomy
Anesthetics
Meta-Analysis
Anesthesia
General Anesthesia
Conscious Sedation
Mortality
Stents
Stroke
Groin
Cerebral Infarction
PubMed
Randomized Controlled Trials
Databases
Equipment and Supplies

Keywords

  • anesthesiology
  • meta analysis
  • outcome
  • stroke care
  • thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

Cite this

Gravel, G., Boulouis, G., Benhassen, W., Rodriguez-Regent, C., Trystram, D., Edjlali-Goujon, M., ... Naggara, O. N. (2019). Anaesthetic management during intracranial mechanical thrombectomy: Systematic review and meta-analysis of current data. Journal of Neurology, Neurosurgery and Psychiatry, 90(1), 68-74. https://doi.org/10.1136/jnnp-2018-318549

Anaesthetic management during intracranial mechanical thrombectomy : Systematic review and meta-analysis of current data. / Gravel, Guillaume; Boulouis, Grégoire; Benhassen, Wagih; Rodriguez-Regent, Christine; Trystram, Denis; Edjlali-Goujon, Myriam; Meder, Jean François; Oppenheim, Catherine; Bracard, Serge; Brinjikji, Waleed; Naggara, Olivier N.

In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 90, No. 1, 01.01.2019, p. 68-74.

Research output: Contribution to journalArticle

Gravel, G, Boulouis, G, Benhassen, W, Rodriguez-Regent, C, Trystram, D, Edjlali-Goujon, M, Meder, JF, Oppenheim, C, Bracard, S, Brinjikji, W & Naggara, ON 2019, 'Anaesthetic management during intracranial mechanical thrombectomy: Systematic review and meta-analysis of current data', Journal of Neurology, Neurosurgery and Psychiatry, vol. 90, no. 1, pp. 68-74. https://doi.org/10.1136/jnnp-2018-318549
Gravel, Guillaume ; Boulouis, Grégoire ; Benhassen, Wagih ; Rodriguez-Regent, Christine ; Trystram, Denis ; Edjlali-Goujon, Myriam ; Meder, Jean François ; Oppenheim, Catherine ; Bracard, Serge ; Brinjikji, Waleed ; Naggara, Olivier N. / Anaesthetic management during intracranial mechanical thrombectomy : Systematic review and meta-analysis of current data. In: Journal of Neurology, Neurosurgery and Psychiatry. 2019 ; Vol. 90, No. 1. pp. 68-74.
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abstract = "Objective Our aim was to compare the clinical outcome of patients with ischaemic stroke with anterior large vessel occlusion treated with stent retrievers and/or contact aspiration mechanical thrombectomy (MT) under general anaesthesia (GA) or conscious sedation non-GA through a systematic review and meta-analysis. Methods The literature was searched using PubMed, Embase and Cochrane databases to identify studies reporting on anaesthesia and MT. Using fixed or random weighted effect, we evaluated the following outcomes: 3-month mortality, modified Rankin Score (mRs) 0-2, recanalisation success (thrombolysis in cerebral infarction (TICI) ≥2b) and symptomatic intracerebral haemorrhagic (sICH) transformation. Results We identified seven cohorts (including three dedicated randomised controlled trials), totalling 1929 patients (932 with GA). Over the entire sample, mortality, mRs 0-2, TICI≥2b and sICH rates were, respectively 17.5{\%} (99{\%} CI 9.7{\%} to 29.6{\%}; Q-value: 60.1; I 2: 93{\%}, 1717 patients), 42.1{\%} (99{\%} CI 33.3{\%} to 51.7{\%}; Q-value: 41.3; I 2: 87.9{\%}), 82.9{\%} (99{\%} CI 74.0{\%} to 89.1{\%}; Q-value: 20.7; I 2: 80.6{\%}, 1006 patients) and 5.5{\%} (99{\%} CI 2.8{\%} to 10.8{\%}; Q-value: 18.6; I 2: 78.5{\%}). MT performed in non-GA patients was associated with better 3-month functional outcome (pooled OR, 1.35; 99{\%} CI 1.04 to 1.76; Q-value: 24.0; I 2: 9.2{\%}, 1845 patients) and lower 3-month mortality rate (pooled OR, 0.70; 99{\%} CI 0.49 to 0.98; Q-value: 1.4; I 2: 0{\%}, 1717 patients; fixed weighted effect model) compared with GA. MT performed under conscious sedation non-GA had significantly shorter onset-to-recanalisation and onset-to-groin delay compared with GA, and recanalisation success and sICH were similar. Conclusion Non-GA during MT for anterior acute ischaemic stroke with current-generation stent retriever/aspiration devices is associated with better 3-month functional outcome and lower mortality rates. These unadjusted estimates are subject to biases and should be interpreted with caution.",
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author = "Guillaume Gravel and Gr{\'e}goire Boulouis and Wagih Benhassen and Christine Rodriguez-Regent and Denis Trystram and Myriam Edjlali-Goujon and Meder, {Jean Fran{\cc}ois} and Catherine Oppenheim and Serge Bracard and Waleed Brinjikji and Naggara, {Olivier N.}",
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TY - JOUR

T1 - Anaesthetic management during intracranial mechanical thrombectomy

T2 - Systematic review and meta-analysis of current data

AU - Gravel, Guillaume

AU - Boulouis, Grégoire

AU - Benhassen, Wagih

AU - Rodriguez-Regent, Christine

AU - Trystram, Denis

AU - Edjlali-Goujon, Myriam

AU - Meder, Jean François

AU - Oppenheim, Catherine

AU - Bracard, Serge

AU - Brinjikji, Waleed

AU - Naggara, Olivier N.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective Our aim was to compare the clinical outcome of patients with ischaemic stroke with anterior large vessel occlusion treated with stent retrievers and/or contact aspiration mechanical thrombectomy (MT) under general anaesthesia (GA) or conscious sedation non-GA through a systematic review and meta-analysis. Methods The literature was searched using PubMed, Embase and Cochrane databases to identify studies reporting on anaesthesia and MT. Using fixed or random weighted effect, we evaluated the following outcomes: 3-month mortality, modified Rankin Score (mRs) 0-2, recanalisation success (thrombolysis in cerebral infarction (TICI) ≥2b) and symptomatic intracerebral haemorrhagic (sICH) transformation. Results We identified seven cohorts (including three dedicated randomised controlled trials), totalling 1929 patients (932 with GA). Over the entire sample, mortality, mRs 0-2, TICI≥2b and sICH rates were, respectively 17.5% (99% CI 9.7% to 29.6%; Q-value: 60.1; I 2: 93%, 1717 patients), 42.1% (99% CI 33.3% to 51.7%; Q-value: 41.3; I 2: 87.9%), 82.9% (99% CI 74.0% to 89.1%; Q-value: 20.7; I 2: 80.6%, 1006 patients) and 5.5% (99% CI 2.8% to 10.8%; Q-value: 18.6; I 2: 78.5%). MT performed in non-GA patients was associated with better 3-month functional outcome (pooled OR, 1.35; 99% CI 1.04 to 1.76; Q-value: 24.0; I 2: 9.2%, 1845 patients) and lower 3-month mortality rate (pooled OR, 0.70; 99% CI 0.49 to 0.98; Q-value: 1.4; I 2: 0%, 1717 patients; fixed weighted effect model) compared with GA. MT performed under conscious sedation non-GA had significantly shorter onset-to-recanalisation and onset-to-groin delay compared with GA, and recanalisation success and sICH were similar. Conclusion Non-GA during MT for anterior acute ischaemic stroke with current-generation stent retriever/aspiration devices is associated with better 3-month functional outcome and lower mortality rates. These unadjusted estimates are subject to biases and should be interpreted with caution.

AB - Objective Our aim was to compare the clinical outcome of patients with ischaemic stroke with anterior large vessel occlusion treated with stent retrievers and/or contact aspiration mechanical thrombectomy (MT) under general anaesthesia (GA) or conscious sedation non-GA through a systematic review and meta-analysis. Methods The literature was searched using PubMed, Embase and Cochrane databases to identify studies reporting on anaesthesia and MT. Using fixed or random weighted effect, we evaluated the following outcomes: 3-month mortality, modified Rankin Score (mRs) 0-2, recanalisation success (thrombolysis in cerebral infarction (TICI) ≥2b) and symptomatic intracerebral haemorrhagic (sICH) transformation. Results We identified seven cohorts (including three dedicated randomised controlled trials), totalling 1929 patients (932 with GA). Over the entire sample, mortality, mRs 0-2, TICI≥2b and sICH rates were, respectively 17.5% (99% CI 9.7% to 29.6%; Q-value: 60.1; I 2: 93%, 1717 patients), 42.1% (99% CI 33.3% to 51.7%; Q-value: 41.3; I 2: 87.9%), 82.9% (99% CI 74.0% to 89.1%; Q-value: 20.7; I 2: 80.6%, 1006 patients) and 5.5% (99% CI 2.8% to 10.8%; Q-value: 18.6; I 2: 78.5%). MT performed in non-GA patients was associated with better 3-month functional outcome (pooled OR, 1.35; 99% CI 1.04 to 1.76; Q-value: 24.0; I 2: 9.2%, 1845 patients) and lower 3-month mortality rate (pooled OR, 0.70; 99% CI 0.49 to 0.98; Q-value: 1.4; I 2: 0%, 1717 patients; fixed weighted effect model) compared with GA. MT performed under conscious sedation non-GA had significantly shorter onset-to-recanalisation and onset-to-groin delay compared with GA, and recanalisation success and sICH were similar. Conclusion Non-GA during MT for anterior acute ischaemic stroke with current-generation stent retriever/aspiration devices is associated with better 3-month functional outcome and lower mortality rates. These unadjusted estimates are subject to biases and should be interpreted with caution.

KW - anesthesiology

KW - meta analysis

KW - outcome

KW - stroke care

KW - thrombectomy

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