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Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

التفاصيل البيبلوغرافية
العنوان: Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data
المؤلفون: Campbell, Bruce C.V., van Zwam, Wim H., Goyal, Mayank, Menon, Bijoy K., Dippel, Diederik W.J., Demchuk, Andrew M., Bracard, Serge, White, Philip, Dávalos, Antoni, Majoie, Charles B.L.M., van der Lugt, Aad, Ford, Gary A., de la Ossa, Natalia Pérez, Kelly, Michael, Bourcier, Romain, Donnan, Geoffrey A., Roos, Yvo B.W.E.M., Bang, Oh Young, Nogueira, Raul G., Devlin, Thomas G., van den Berg, Lucie A., Clarençon, Frédéric, Burns, Paul, Carpenter, Jeffrey, Berkhemer, Olvert A., Yavagal, Dileep R., Pereira, Vitor Mendes, Ducrocq, Xavier, Dixit, Anand, Quesada, Helena, Epstein, Jonathan, Davis, Stephen M., Jansen, Olav, Rubiera, Marta, Urra, Xabier, Micard, Emilien, Lingsma, Hester F., Naggara, Olivier, Brown, Scott, Guillemin, Francis, Muir, Keith W., van Oostenbrugge, Robert J., Saver, Jeffrey L., Jovin, Tudor G., Hill, Michael D., Mitchell, Peter J., Fransen, Puck SS, Beumer, Debbie, Yoo, Albert J., Schonewille, Wouter J., Vos, Jan Albert, Nederkoorn, Paul J., Wermer, Marieke JH, van Walderveen, Marianne AA, Staals, Julie, Hofmeijer, Jeannette, van Oostayen, Jacques A., Lycklama à Nijeholt, Geert J., Boiten, Jelis, Brouwer, Patrick A., Emmer, Bart J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., Kappelle, Jaap, Lo, Rob H., van Dijk, Ewoud J., de Vries, Joost, de Kort, Paul L.M., van Rooij, Willem Jan J., van den Berg, Jan S.P., van Hasselt, Boudewijn A.A.M., Aerden, Leo A.M., Dallinga, René J., Visser, Marieke C., Bot, Joseph C.J., Vroomen, Patrick C., Eshghi, Omid, Schreuder, Tobien H.C.M.L., Heijboer, Roel J.J., Keizer, Koos, Tielbeek, Alexander V., den Hertog, Heleen M., Gerrits, Dick G., van den Berg-Vos, Renske M., Karas, Giorgos B., Steyerberg, Ewout W., Flach, Zwenneke, Marquering, Henk A., Sprengers, Marieke E.S., Jenniskens, Sjoerd F.M., Beenen, Ludo F.M., van den Berg, René, Koudstaal, Peter J.
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المصدر: The Lancet Neurology[ISSN 1474-4422],v. 17(1), p. 47-53 (Enero 2018)
سنة النشر: 2018
المجموعة: Universidad de Las Palmas de Gran Canaria: Acceda
مصطلحات موضوعية: 32 Ciencias médicas, 320507 Neurología, Brain Ischemia, Anesthesia, Stroke, Thrombectomy
الوصف: Background: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. Methods: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered. Findings: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had ...
نوع الوثيقة: article in journal/newspaper
اللغة: English
تدمد: 1474-4422
العلاقة: The Lancet Neurology; 17; http://hdl.handle.net/10553/52001Test; 85039561512; Sí
DOI: 10.1016/S1474-4422(17)30407-6
الإتاحة: https://doi.org/10.1016/S1474-4422Test(17)30407-6
http://hdl.handle.net/10553/52001Test
رقم الانضمام: edsbas.54582E3A
قاعدة البيانات: BASE
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