General anesthesia versus monitored anesthesia care during endovascular therapy for vertebrobasilar stroke

Guangjun Hu; Zhen Shi; Bixi Li; Weidong Shao; Bo Xu

General anesthesia versus monitored anesthesia care during endovascular therapy for vertebrobasilar stroke

Am J Transl Res. 2021 Mar 15;13(3):1558-1567. eCollection 2021.

Authors

Guangjun Hu^{1

2

3}, Zhen Shi^{4

5}, Bixi Li⁶, Weidong Shao², Bo Xu^{1

2}

Affiliations

¹ The First Clinical College of Southern Medical University Guangzhou, Guangdong Province, China.
² Department of Anesthesiology, General Hospital of The Southern Theater Command of The Chinese PLA Guangzhou, Guangdong Province, China.
³ Department of Anesthesiology, Wuhan Third Hospital/Tongren Hospital of Wuhan University Wuhan, Hubei Province, China.
⁴ Department of Pain Treatment, Hubei Provincial Hospital of Traditional Chinese Medicine Wuhan, Hubei Province, China.
⁵ Hubei Provincial Academy of Traditional Chinese Medicine Wuhan, Hubei Province, China.
⁶ Department of Anesthesiology, General Hospital of The Central Theater Command of The Chinese PLA Wuhan, Hubei Province, China.

PMID: 33841679
PMCID: PMC8014376

Abstract

Objective: The objective is to compare the effect of general anesthesia (GA) and monitored anesthesia care (MAC) on clinical outcomes in patients with endovascular therapy for vertebrobasilar occlusion stroke.

Methods: 139 patients undergoing endovascular therapy for vertebrobasilar stroke, were recruited. The patients were randomized into GA group and MAC group (about 1:1 ratio). GA group received general anesthesia and MAC group received monitored anesthesia care during endovascular therapy. The primary outcome measure was the shift in the degree of disability among the 2 groups as measured by the modified Rankin scale score (mRS) at 90 days (80-100 days). Secondary end points included infarct volume and related complications.

Results: The patients were assigned randomly (about 1:1 allocation) to GA group (n=72) and MAC group (n=67). The primary outcome of functional independence measured by 90-day mRS score was not significantly different between the 2 groups (median (IQR), 2 (1-3) vs. 3 (1-4); P=0.316). Final infarct volume was smaller in the GA group than in the MAC group (median (IQR), 27.60 (13.75-83.52) vs. 33.60 (26.85-92.95); P=0.045). There were no differences with statistical significance in rates of successful reperfusion (modified Thrombolysis in Cerebral Ischemia (mTICI) 2b-3) between 2 groups (73.61% vs. 76.12%; P=0.734). Early neurological outcomes measured by the 24-hour National Institutes of Health Stroke Scale scores (NIHSS) showed that 11 (interquartile range (IQR), 3-22) in GA group and 11 (interquartile range (IQR), 7-25) in MAC group, but were not statistically significant. There was no statistical difference in postoperative complications between the two groups.

Conclusion: For patients who underwent endovascular therapy for vertebrobasilar occlusion strok caused by occlusions in the posterior circulation, MAC appears to be as effective as GA. However, MAC is associated with bigger final infarct volume. Future studies are warranted to confirm our findings.

Keywords: General anesthesia; endovascular therapy; monitored anesthesia care; vertebrobasilar stroke.