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Research paper
Anaesthetic management during intracranial mechanical thrombectomy: systematic review and meta-analysis of current data
  1. Guillaume Gravel1,
  2. Grégoire Boulouis1,
  3. Wagih Benhassen1,
  4. Christine Rodriguez-Regent1,
  5. Denis Trystram1,
  6. Myriam Edjlali-Goujon1,
  7. Jean-François Meder1,
  8. Catherine Oppenheim1,
  9. Serge Bracard2,
  10. Waleed Brinjikji3,
  11. Olivier N Naggara1
  1. 1 INSERM UMR 894, Department of Neuroradiology, Centre Hospitalier Sainte Anne, Université Paris-Descartes, Paris, France
  2. 2 Department of Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
  3. 3 Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Olivier N Naggara, Neuroradiology Department, Centre Hospitalier Sainte-Anne, Paris 75014 , France; O.NAGGARA{at}ch-sainte-anne.fr

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; I2: 93%, 1717 patients), 42.1% (99% CI 33.3% to 51.7%; Q-value: 41.3; I2: 87.9%), 82.9% (99% CI 74.0% to 89.1%; Q-value: 20.7; I2: 80.6%, 1006 patients) and 5.5% (99% CI 2.8% to 10.8%; Q-value: 18.6; I2: 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; I2: 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; I2: 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.

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

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Footnotes

  • GG and GB contributed equally.

  • Contributors All authors: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data; drafting the work or revising it critically for important intellectual content; final approval of the version published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Data acquisition: ONN, GB, GG. Data analysis: ONN, GB, GG. Drafting: ONN, GG, GB. Critical revisions: GB, GG, WBe, CR-R, DT, ME-G, J-FM, CO, SB, WBr.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors agree to share any unpublished data related to this study (study protocol, analysis plan), which can be asked from the corresponding author.

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