Anesthesia Modality in Intracranial Stenting for Acute Stroke-A Sub-Analysis of the RESISTANT International Registry.

IF 3.2 3区医学 Q2 CLINICAL NEUROLOGY

Clinical Neuroradiology Pub Date : 2026-06-01 Epub Date: 2026-02-03 DOI:10.1007/s00062-026-01619-7

João André Sousa, Marta Olivé-Gadea, Francesco Diana, Johannes Kaesmacher, Adnan Mujanovic, Serdar Geyik, Songul Senadim, Amedeo Cervo, Andrea Salcuni, Mariangela Piano, Manuel Moreu, Alfonso López-Frías, Ameer Hassan, Samantha Miller, Elena Zapata-Arriaza, Asier de Albóniga-Chindurza, Mauro Bergui, Stefano Molinaro, Fabio Gomes, Joao Sargento-Freitas, Andrea Alexandre, Alessandro Pedicelli, Jeremy Hofmeister, Paolo Machi, Luca Scarcia, Erwah Kalsoum, Jose Amorim, Torcato Meira, Santiago Ortega Gutierrez, Aaron Rodriguez-Calienes, Leonardo Renieri, Francesco Capasso, Daniele Romano, Eduardo Bárcena-Ruiz, David Seoane, Mohamad Abdalkader, Piers Klein, Thanh N Nguyen, Catarina Perry, Isabel Fragata, Dileep Yavagal, Jude Charles, Jose Rodriguez Castro, Pedro Vega, Atilla Özcan Özdemir, Zehra Uysal Kocabaş, Stanislas Smajda, Sadiq Al Salman, Jane Khalife, Tudor Jovin, Francesco Biraschi, Francesca Ricchetti, Pedro Castro, Luis Albuquerque, Adnan Siddiqui, Vinay Jaikumar, Pedro Navia, Nikos Ntoulias, Marios Psychogios, Mariano Velo, Joaquin Zamarro, Gonzalo De Paco, Yazan Ashouri, Mohammad AlMajali, Juan F Arenillas, Alicia Sierra, Michele Romoli, João Pedro Marto, Shadi Yaghi, Marc Ribo, Alejandro Tomasello, Manuel Requena

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引用次数: 0

Abstract

Purpose: The optimal anesthetic approach for intracranial stenting in acute stroke remains unclear. We compared outcomes of patients under general anesthesia (GA) versus local anesthesia or conscious sedation.

Methods: The RESISTANT registry is a multicenter observational study on acute intracranial stenting during thrombectomy. Patients treated between January 2016 and June 2023 were included and stratified into GA and local anestesia/conscious sedation groups. The primary outcome was an adjusted shift analysis of the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included mRS 0-2 at 90 days and final modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 scores. Safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality. Adjusted ordinal and logistic regression with mixed-effects models were performed.

Results: Of 876 patients, 445 (50.8%) received GA. Median age was 67 years [59-77]; 567 (64.8%) were men. No differences were found in 90-day mRS (adjusted common OR = 1.256 [0.887-1.780], p = 0.199). Rates of functional independence (39.0% vs 44.5%; aOR = 0.956 [0.606-1.507], p = 0.846), mTICI 2c/3 (68.9% vs 68.7%; aOR = 0.941 [0.602-1.471], p = 0.790), and sICH (8.0% vs 8.6%; aOR = 0.769 [0.374-1.584], p = 0.477) were comparable. In-hospital (23.0% vs 12.0%; aOR = 2.39 [1.35-4.22], p = 0.003) and 90-day mortality (33.3% vs 21.1%; aOR = 2.017 [1.227-3.315], p = 0.006) were higher in the GA group.

Conclusion: In patients undergoing intracranial stenting during thrombectomy, anesthesia modality was not associated with better outcomes. GA was linked to higher mortality, likely due to indication bias.

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急性脑卒中颅内支架植入术的麻醉方式——耐药国际注册的亚分析。

目的：急性脑卒中颅内支架置入术的最佳麻醉入路尚不清楚。我们比较了全身麻醉（GA）与局部麻醉或清醒镇静下患者的结果。方法：耐药登记是一项多中心观察研究急性颅内支架在血栓切除术。纳入2016年1月至2023年6月期间接受治疗的患者，并将其分为GA组和局部麻醉/清醒镇静组。主要结局是90天的修正Rankin量表（mRS）的调整偏移分析。次要结局包括90天mRS 0-2和最终改良脑梗死溶栓（mTICI） 2c/3评分。安全性结果为症状性颅内出血（siich）和死亡率。采用混合效应模型进行调整有序和逻辑回归。结果：876例患者中，445例（50.8%）接受GA治疗。中位年龄67岁[59-77]；男性567例（64.8%）。90天mRS差异无统计学意义（调整后常见OR = 1.256 [0.887-1.780],p = 0.199）。功能独立性（39.0% vs 44.5%; aOR = 0.956 [0.606-1.507],p = 0.846）、mTICI 2c/3 （68.9% vs 68.7%; aOR = 0.941 [0.602-1.471],p = 0.790）和sICH （8.0% vs 8.6%; aOR = 0.769 [0.374-1.584],p = 0.477）具有可比性。GA组住院死亡率（23.0% vs 12.0%; aOR = 2.39 [1.35-4.22],p = 0.003）和90天死亡率（33.3% vs 21.1%; aOR = 2.017 [1.227-3.315],p = 0.006）较高。结论：在取栓期间接受颅内支架植入术的患者中，麻醉方式与更好的预后无关。GA与较高的死亡率有关，可能是由于适应症偏倚。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neuroradiology CLINICAL NEUROLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

5.00

自引率

3.60%

发文量

106

审稿时长

>12 weeks

期刊介绍： Clinical Neuroradiology provides current information, original contributions, and reviews in the field of neuroradiology. An interdisciplinary approach is accomplished by diagnostic and therapeutic contributions related to associated subjects. The international coverage and relevance of the journal is underlined by its being the official journal of the German, Swiss, and Austrian Societies of Neuroradiology.