Publication

Impact of Anesthetic Management on Safety and Outcomes Following Mechanical Thrombectomy for Ischemic Stroke in SWIFT PRIME Cohort

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Last modified
  • 05/21/2025
Type of Material
Authors
    Omer F. Eker, Hospices Civils de LyonJeffrey L. Saver, University of California Los AngelesMayank Goyal, University of CalgaryReza Jahan, University of California Los AngelesElad I. Levy, State University of New York BuffaloRaul Nogueira, Emory UniversityDileep R. Yavagal, University of MiamiAlain Bonafe, Hopital Gue-de-Chauliac
Language
  • English
Date
  • 2018-08-29
Publisher
  • Frontiers Media
Publication Version
Copyright Statement
  • © 2018 Eker, Saver, Goyal, Jahan, Levy, Nogueira, Yavagal, Bonafé and SWIFT PRIME investigators.
License
Final Published Version (URL)
Title of Journal or Parent Work
ISSN
  • 1664-2295
Volume
  • 9
Issue
  • AUG
Start Page
  • 702
End Page
  • 702
Grant/Funding Information
  • SWIFT PRIME trial (Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke) was funded by Covidien.
Supplemental Material (URL)
Abstract
  • Background and purpose: The optimal anesthetic management of acute ischemic stroke patients during mechanical thrombectomy (MT) remains controversial. In this post-hoc analysis, we investigated the impact of anesthesia type on clinical outcomes in patients included in SWIFT PRIME trial. Methods: Ninety-seven patients treated with MT were included. Patients treated in centers with general anesthesia (GA) policy (n = 32) were compared with those treated in centers with conscious sedation (CS) policy (n = 65). Primary outcomes studied included times to treatment initiation (TTI), rates of successful recanalization (TICI 2b/3), and functional independence (mRS 0-2 at 90 days). Secondary outcomes were adverse events, lowest systolic and diastolic blood pressures (LSBP and LDBP) during MT. Univariate analysis and multivariate regression logistic modeling were conducted. Results: The GA-policy and CS-policy groups presented comparable TTI (94 ± 36 min vs. 102 ± 48 min; p = 0.44), rates of TICI 2b/3 recanalization (22/32 [68.8%] vs. 51/65 [78.5%]; p = 0.32). CS-policy was associated to higher rate of functional independence than GA-policy, but the difference was not significant (43/65 [66.2%] vs. 16/32 [50.0%]; p = 0.18). GA-policy patients had a higher rate of postoperative pneumonia (11/32 [34.4%] vs. 8/65 [12.3%]; p = 0.02) and lower LSBP (110 [30,160] mmHg vs. 119 [77,170] mmHg; p = 0.03) and LDBP (55 (15,75) mmHg vs. 67 [40,121]; p < 0.001). When corrected for differences in baseline characteristics, GA-policy was associated with lower rate of functional independence (OR 0.32; p = 0.05). A 10-point increase in perprocedural LDBP was associated with an increased likelihood of favorable outcome (OR 1.51; p = 0.01). Conclusions: GA-policy for MT presented comparable TTI and rates of successful revascularization to CS-policy. However, GA-policy was associated with lower rates of functional independence and with higher incidence of perprocedural hypotension and postoperative pneumonia.
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Keywords
Research Categories
  • Health Sciences, Medicine and Surgery
  • Biology, Neuroscience

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