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Tytuł:
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Local anesthesia versus general anesthesia during endovascular therapy for acute stroke: a propensity score analysis.
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Autorzy:
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Pop, Raoul
Severac, François
Happi Ngankou, Emmanuel
Harsan, Oana
Martin, Ioan
Mihoc, Dan
Manisor, Monica
Simu, Mihaela
Chibbaro, Salvatore
Wolff, Valérie
Gheoca, Roxana
Meyer, Alain
Pottecher, Julien
Audibert, Gérard
Derelle, Anne-Laure
Tonnelet, Romain
Liang Liao
Zhu, François
Bracard, Serge
Anxionnat, René
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Temat:
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ENDOVASCULAR surgery
CEREBRAL ischemia
CONFIDENCE intervals
LOCAL anesthesia
MEDICAL records
PROBABILITY theory
STROKE
SURGICAL complications
VEIN surgery
TREATMENT effectiveness
RETROSPECTIVE studies
DESCRIPTIVE statistics
GENERAL anesthesia
ACQUISITION of data methodology
ODDS ratio
THROMBECTOMY
EVALUATION
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Źródło:
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Journal of NeuroInterventional Surgery; Mar2021, Vol. 13 Issue 3, p207-211, 5p
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Background To date, the choice of optimal anesthetic management during endovascular therapy (EVT) of acute ischemic stroke patients remains subject to debate. We aimed to compare functional outcomes and complication rates of EVT according to the first-line anesthetic management in two comprehensive stroke centers: local anesthesia (LA) versus general anesthesia (GA). Methods Retrospective analysis of prospectively collected databases, identifying all consecutive EVT for strokes in the anterior circulation performed between January 1, 2018 and December 31, 2018 in two EVT-capable stroke centers. One center performed EVT under LA in the first intention, while the other center systematically used GA. Using propensity score analysis, the two groups underwent 1:1 matching, then procedural metrics, complications, and clinical outcomes were compared. Good outcome was defined as 90 days modified Rankin Scale (mRS) <2, and successful recanalization as modified Thrombolysis In Cerebral Ischemia (mTICI) 2b-3. Results During the study period, 219 patients were treated in the LA center and 142 in the GA center. Using the propensity score, 97 patients from each center were matched 1:1 according to the baseline characteristics. Local anesthesia was associated with a significantly lower proportion of good outcome (36.1% vs 52.0%, OR 0.53, 95% CI 0.33 to 0.87; p=0.039), lower rate of successful recanalization (70.1% vs 95.8%, OR 0.13, 95% CI 0.04 to 0.39; p<0.001), and more procedural complications (14.4% vs 3.0%, OR 3.44, 95% CI 1.09 to 14.28; p=0.018). There were no significant differences in 90-day mortality or symptomatic hemorrhagic transformation rates. Conclusions In this study, systematic use of GA for stroke EVT was associated with better clinical outcomes, higher recanalization rates, and fewer procedural complications compared with patients treated under LA as the primary anesthetic approach. [ABSTRACT FROM AUTHOR]
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