Abstract
Abstract 42: The Effect Of Anesthesia On Thrombectomy Outcomes Is Modified By Collateral Flow: Pooled Patient Level Analysis From EXTEND-IA, EXTEND-IA TNK Part I And II, And SELECT
Stroke (1970), Vol.53(Suppl_1), p.A42
02/2022
DOI: 10.1161/str.53.suppl_1.42
Abstract
Background:
The effect of anesthesia choice on endovascular thrombectomy (EVT) outcomes is unclear. Collateral status on perfusion imaging may help identify the optimal anesthesia choice.
Methods:
In a pooled patient level analysis of EXTEND-IA, EXTEND-IA TNK, EXTEND-IA TNK part II and SELECT, EVT Functional outcomes (mRS distribution) were compared between general anesthesia (GA) vs non-general anesthesia (non-GA). Further, we assessed the impact of collateral flow on perfusion imaging evaluated by hypoperfusion intensity ratio (HIR) - Tmax10 sec/Tmax6 sec) on the association between anesthesia type and EVT outcomes.
Results:
Of 731 treated with EVT, 305 (42%) received GA and 426 (58%) non-GA. The baseline characteristics were similar, except for presentation NIHSS (median [IQR] GA 18 [13-22], non-GA 16[11-20], p<0.001) and ischemic core volume (GA 14.1mL [3-37] vs non-GA 9mL [0-31], p=0.002). GA was associated with longer LKW to arterial access (203min [158-267] vs 186min [138-252], p=0.002), but similar procedural time (36min [23-59] vs 34min [22-54], p=0.36). Non-GA was independently associated with improved functional outcomes (adj cOR 1.42, 95%CI 1.05-1.93, p=0.024) and lower mortality (17% vs 11.3%, p=0.025). Patients with poor collaterals (HIR≥0.4) had improved functional outcomes with non-GA (adj cOR 1.53, 95%CI 1.02-2.29, p=0.038), while no difference was observed in those with good collaterals-HIR<0.4 (adj cOR 1.38, 95% CI 0.84-2.27, p=0.21).
Conclusion:
GA was associated with worse functional outcomes after EVT, particularly in patients with poor collaterals. These findings have implications for randomized trials of GA vs non-GA.
Details
- Title: Subtitle
- Abstract 42: The Effect Of Anesthesia On Thrombectomy Outcomes Is Modified By Collateral Flow: Pooled Patient Level Analysis From EXTEND-IA, EXTEND-IA TNK Part I And II, And SELECT
- Creators
- Amrou Sarraj - Western UniversityGregory Albers - Stanford UniversityAmeer Hassan - Valley Baptist Medical CenterMichael G Abraham - University of KansasSpiros Blackburn - The University of Texas Health Science CenterMuhammad Hussain - Cleveland ClinicWondwossen Tekle - Valley Baptist Medical CenterSantiago Ortega-Gutierrez - University of IowaAmin N Aghaebrahim - Baptist Health, Ponte Vedra Beach, FLDiogo C Haussen - Emory UniversityGabor Toth - Cleveland ClinicRonald Budzik - Riverside Methodist HospitalDeep K Pujara - Western UniversityWilliam J Hicks - Riverside Methodist HospitalNirav Vora - Neurology, OhioHealth - Riverside Methodist Hosp, Colombus, OHRandall C Edgell - Saint Louis UniversitySabreena Slavin - University of KansasColleen G Lechtenberg - University of KansasLaith N Maali - University of KansasAbid Y Qureshi - University of KansasLee Rosterman - University of KansasBenjamin AertkerMohammad A Abdulrazzak - Cleveland ClinicOsman Mir - NYU, Coppell, TXKaushik N Parsha - Baptist Memorial Health CareSujan S Reddy - Mercy HealthBader Alenzi - Mercy St. Vincent Medical CenterChunyan Cai - The University of Texas Health Science CenterTareq S Almaghrabi - University of TabukFaris Shaker - The University of Texas Health Science CenterHaris Kamal - Westchester Medical CenterAshish Arora - Greensboro CollegeNawaf Yassi - Royal Melbourne HospitalGagan J Sharma - Royal Melbourne HospitalTimothy J Kleinig - Royal Adelaide HospitalDarshan Shah - Gold Coast HealthTeddy Y Wu - Neurology, Christchurch Hosp, Christchurch, New ZealandSheryl B Martin-schild - Dr. Brain, Inc., Metairie, LAArthur L Day - The University of Texas Health Science Centerclark W sitton - The University of Texas Health Science CenterPeter J Mitchell - Royal Melbourne HospitalRishi Gupta - WellStar Health SystemMaarten G Lansberg - Stanford UniversityRaul G Nogueira - Emory UniversityGeoffrey A Donnan - The Royal Melbourne HospitalStephen Davis - Royal Melbourne HospitalJames C Grotta - Memorial HermannBruce C Campbell - Royal Melbourne Hospital
- Resource Type
- Abstract
- Publication Details
- Stroke (1970), Vol.53(Suppl_1), p.A42
- DOI
- 10.1161/str.53.suppl_1.42
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Language
- English
- Date published
- 02/2022
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984303435002771
Metrics
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