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The effect of anesthetic management during intra-arterial therapy for acute stroke in MR CLEAN

2016; Lippincott Williams & Wilkins; Volume: 87; Issue: 7 Linguagem: Inglês

10.1212/wnl.0000000000002976

1526-632X

Olvert A. Berkhemer, Lucie A. van den Berg, Puck Fransen, Debbie Beumer, Albert J. Yoo, Hester F. Lingsma, Wouter J. Schonewille, René van den Berg, Marieke J.H. Wermer, Jelis Boiten, Geert J. Lycklama à Nijeholt, Paul J. Nederkoorn, Markus W. Hollmann, Wim H. van Zwam, Aad van der Lugt, Robert J. van Oostenbrugge, Charles B.L.M. Majoie, Diederik W.J. Dippel, Yvo B.W.E.M. Roos, Diederik W.J. Dippel, Yvo B.W.E.M. Roos, Robert van Oostenbrugge, Jelis Boiten, Marieke J.H. Wermer, Jaap Kappelle, Ewoud van Dijk, Wouter J. Schonewille, Jeannette Hofmeijer, Patrick C. Vroomen, Paul de Kort, Koos Keizer, Sebastiaan de Bruijn, Peter van den Berg, Tobien H.C.M.L. Schreuder, Leo A.M. Aerden, Marieke C. Visser, Heleen den Hertog, Patrick A. Brouwer, Charles B.L.M. Majoie, Wim H. van Zwam, Geert J. Lycklama à Nijeholt, Marianne van Walderveen, Rob H. Lo, Joost de Vries, Jan Albert Vos, Jacques van Oostayen, Omid Eshgi, Xander Tielbeek, Lukas van Dijk, Boudewijn van Hasselt, Roel J.J. Heijboer, René J. Dallinga, Joost Bot, Dick Gerrits, Olvert A Berkhemer, Lucie van den Berg, Debbie Beumer, Puck Fransen, Aad van der Lugt, Henk A. Marquering, Ludo F.M. Beenen, Marieke E.S. Sprengers, René van den Berg, Hester F. Lingsma, Martin M. Brown, Theo Stijnen, Thomas Liebig, Zwenneke Flach, Albert J. Yoo, Peter J. Koudstaal, Ewout W. Steyerberg, Tommy Andersson, Heinrich P. Mattle, Nils Wahlgren, Sjoerd F.M. Jenniskens, Renske M. van den Berg‐Vos, Giorgos B. Karas, Paul J. Nederkoorn, Julie Staals, Bart J. Emmer,

Venous Thromboembolism Diagnosis and Management

Background: The aim of the current study was to assess the influence of anesthetic management on the effect of treatment in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN). Methods: MR CLEAN was a multicenter, randomized, open-label trial of intra-arterial therapy (IAT) vs no IAT. The intended anesthetic management at the start of the procedure was used for this post hoc analysis. The primary effect parameter was the adjusted common odds ratio (acOR) for a shift in direction of a better outcome on the modified Rankin Scale (mRS) at 90 days, estimated with multivariable ordinal logistic regression analysis, which included a term for general anesthesia (GA). Results: GA was associated with significant ( p = 0.011) effect modification, resulting in estimated decrease of 51% (95% confidence interval [CI] 31%–86%) in treatment effect compared to non-GA. We found a shift in the distribution on the mRS in favor of non-GA compared to control group (acOR 2.18 [95% CI 1.49–3.20]). The shift in distribution between GA and control group was in a similar direction (acOR 1.12 [95% CI 0.71–1.78]) with loss of statistical significance. Conclusions: In this post hoc analysis, we found that the type of anesthetic management influences outcome following IAT. Only treatment without general anesthesia was associated with a significant treatment benefit in MR CLEAN. Classification of evidence: This study provides Class II evidence that for patients with acute ischemic stroke undergoing IAT, mRS scores at 90 days improve only in patients treated without GA.