Moreover, conversion from non-GA to GA was 6 of 137 (4.4%). 7 Also, GA was associated with delayed initiation of interventional therapy in comparison with conscious sedation (CS 162☖9 versus 134☖0 minutes). In a post hoc analysis of MR CLEAN for use of GA, Berkhemer reported at the International Stroke Conference in Nashville, TN, a favorable effect when non-GA was used instead of GA (mRS, 0–2 at 90 days 38% versus 23% P=0.013). A recent meta-analysis by Fargen 5, 6 included MR CLEAN and the prior endovascular stroke trials and suggested a favorable shift outcome (mRS, 0–2 good outcome by 90 days OR, 1.67 95% CI, 1.29–1.16 P=0.0001) for patients with large-vessel occlusions who receive interventional therapy. Furthermore, lower mortality rate was seen in intervention group (10.4 versus 19.0 P=0.04). The rate of functional independence (mRS, 0–2 by 90 days) was higher in the intervention group (53.0% versus 29.3% P<0.01).
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In contrast, 9% of the patients in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) 4 trial received GA. General anesthesia (GA) was used in 38% of the patients in the interventional group of MR CLEAN. Improvement in mRS was noted for all categories except for death. The study demonstrated a favorable shift in outcomes in the interventional group by modified Rankin Scale (mRS) by 90 days (odds ratio, 1.67 95% confidence interval, 1.21–2.30).
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1, 2 However, the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trial 3 compared patients with acute stroke with proximal anterior circulation artery occlusions with usual stroke care, including intravenous tissue-type plasminogen activator (tPA).
The use of acute endovascular stroke intervention was called into question after the results of 2 negative stroke endovascular trials (Interventional Management of Stroke 3 and Systemic Thrombolysis for Acute Ischemic Stroke per the Stroke Center registry ). Customer Service and Ordering Information.
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