North American SOLITAIRE stent-retriever acute stroke registry: Choice of anesthesia and outcomes

Alex Abou-Chebl, Ossama O. Zaidat, Alicia C. Castonguay, Rishi Gupta, Chung Huan J. Sun, Coleman O. Martin, William E. Holloway, Nils Mueller-Kronast, Joey D. English, Italo Linfante, Guilherme Dabus, Timothy W. Malisch, Franklin A. Marden, Hormozd Bozorgchami, Andrew Xavier, Ansaar T. Rai, Micahel T. Froehler, Aamir Badruddin, Thanh N. Nguyen, Muhammad TaqiMichael G. Abraham, Vallabh Janardhan, Hashem Shaltoni, Roberta Novakovic, Albert J. Yoo, Peng R. Chen, Gavin W. Britz, Ritesh Kaushal, Ashish Nanda, Mohammad A. Issa, Raul G. Nogueira

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE-: Previous work that predated the availability of the safer stent-retriever devices has suggested that general anesthesia (GA) may have a negative impact on outcomes in patients with acute ischemic stroke undergoing endovascular therapy. METHODS-: We reviewed demographic, clinical, procedural (GA versus local anesthesia [LA], etc), and site-adjudicated angiographic and clinical outcomes data from consecutive patients treated with the Solitaire FR device in the investigator-initiated North American SOLITAIRE Stent-Retriever Acute Stroke (NASA) Registry. The primary outcomes were 90-day modified Rankin Scale, mortality, and symptomatic intracranial hemorrhage. RESULTS-: A total of 281 patients from 18 centers were enrolled. GA was used in 69.8% (196/281) of patients. Baseline demographic and procedural factors were comparable between the LA and GA groups, except the former demonstrated longer time-to-groin puncture (395.4±254 versus 337.4±208 min; P=0.04), lower National Institutes of Health Stroke Scale (NIHSS; 16.2±5.8 versus 18.8±6.9; P=0.002), lower balloon-guide catheter usage (22.4% versus 49.2%; P=0.0001), and longer fluoroscopy times (39.5±33 versus 28±22.8 min; P=0.008). Recanalization (thrombolysis in cerebral infarction ?2b; 72.94% versus 73.6%; P=0.9) and rate of symptomatic intracranial hemorrhage (7.1% versus 11.2%; P=0.4) were similar but modified Rankin Scale ≤2 was achieved in more LA patients, 52.6% versus 35.6% (odds ratio, 1.4 [1.1-1.8]; P=0.01). In multivariate analysis, hypertension, NIHSS, unsuccessful revascularization, and GA use (odds ratio, 3.3 [1.6-7.1]; P=0.001) were associated with death. When only anterior circulation and elective GA patients were included, there was a persistent difference in good outcomes in favor of LA patients (50.7% versus 35.5%; odds ratio, 1.3 [1.01-1.6]; P=0.04). CONCLUSIONS-: The NASA Registry has demonstrated that clinical outcomes and survival are significantly better in patients treated with LA, without increased symptomatic intracranial hemorrhage risk. Future trials should prospectively evaluate the effect of GA on outcomes.

Original languageEnglish (US)
Pages (from-to)1396-1401
Number of pages6
JournalStroke
Volume45
Issue number5
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Stents
Registries
General Anesthesia
Anesthesia
Stroke
Local Anesthesia
Intracranial Hemorrhages
Odds Ratio
Demography
Equipment and Supplies
Groin
Fluoroscopy
Cerebral Infarction
National Institutes of Health (U.S.)
Punctures
Multivariate Analysis
Catheters
Research Personnel
Hypertension
Survival

Keywords

  • Anesthesia
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Abou-Chebl, A., Zaidat, O. O., Castonguay, A. C., Gupta, R., Sun, C. H. J., Martin, C. O., ... Nogueira, R. G. (2014). North American SOLITAIRE stent-retriever acute stroke registry: Choice of anesthesia and outcomes. Stroke, 45(5), 1396-1401. https://doi.org/10.1161/STROKEAHA.113.003698

North American SOLITAIRE stent-retriever acute stroke registry : Choice of anesthesia and outcomes. / Abou-Chebl, Alex; Zaidat, Ossama O.; Castonguay, Alicia C.; Gupta, Rishi; Sun, Chung Huan J.; Martin, Coleman O.; Holloway, William E.; Mueller-Kronast, Nils; English, Joey D.; Linfante, Italo; Dabus, Guilherme; Malisch, Timothy W.; Marden, Franklin A.; Bozorgchami, Hormozd; Xavier, Andrew; Rai, Ansaar T.; Froehler, Micahel T.; Badruddin, Aamir; Nguyen, Thanh N.; Taqi, Muhammad; Abraham, Michael G.; Janardhan, Vallabh; Shaltoni, Hashem; Novakovic, Roberta; Yoo, Albert J.; Chen, Peng R.; Britz, Gavin W.; Kaushal, Ritesh; Nanda, Ashish; Issa, Mohammad A.; Nogueira, Raul G.

In: Stroke, Vol. 45, No. 5, 01.01.2014, p. 1396-1401.

Research output: Contribution to journalArticle

Abou-Chebl, A, Zaidat, OO, Castonguay, AC, Gupta, R, Sun, CHJ, Martin, CO, Holloway, WE, Mueller-Kronast, N, English, JD, Linfante, I, Dabus, G, Malisch, TW, Marden, FA, Bozorgchami, H, Xavier, A, Rai, AT, Froehler, MT, Badruddin, A, Nguyen, TN, Taqi, M, Abraham, MG, Janardhan, V, Shaltoni, H, Novakovic, R, Yoo, AJ, Chen, PR, Britz, GW, Kaushal, R, Nanda, A, Issa, MA & Nogueira, RG 2014, 'North American SOLITAIRE stent-retriever acute stroke registry: Choice of anesthesia and outcomes', Stroke, vol. 45, no. 5, pp. 1396-1401. https://doi.org/10.1161/STROKEAHA.113.003698
Abou-Chebl A, Zaidat OO, Castonguay AC, Gupta R, Sun CHJ, Martin CO et al. North American SOLITAIRE stent-retriever acute stroke registry: Choice of anesthesia and outcomes. Stroke. 2014 Jan 1;45(5):1396-1401. https://doi.org/10.1161/STROKEAHA.113.003698
Abou-Chebl, Alex ; Zaidat, Ossama O. ; Castonguay, Alicia C. ; Gupta, Rishi ; Sun, Chung Huan J. ; Martin, Coleman O. ; Holloway, William E. ; Mueller-Kronast, Nils ; English, Joey D. ; Linfante, Italo ; Dabus, Guilherme ; Malisch, Timothy W. ; Marden, Franklin A. ; Bozorgchami, Hormozd ; Xavier, Andrew ; Rai, Ansaar T. ; Froehler, Micahel T. ; Badruddin, Aamir ; Nguyen, Thanh N. ; Taqi, Muhammad ; Abraham, Michael G. ; Janardhan, Vallabh ; Shaltoni, Hashem ; Novakovic, Roberta ; Yoo, Albert J. ; Chen, Peng R. ; Britz, Gavin W. ; Kaushal, Ritesh ; Nanda, Ashish ; Issa, Mohammad A. ; Nogueira, Raul G. / North American SOLITAIRE stent-retriever acute stroke registry : Choice of anesthesia and outcomes. In: Stroke. 2014 ; Vol. 45, No. 5. pp. 1396-1401.
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TY - JOUR

T1 - North American SOLITAIRE stent-retriever acute stroke registry

T2 - Choice of anesthesia and outcomes

AU - Abou-Chebl, Alex

AU - Zaidat, Ossama O.

AU - Castonguay, Alicia C.

AU - Gupta, Rishi

AU - Sun, Chung Huan J.

AU - Martin, Coleman O.

AU - Holloway, William E.

AU - Mueller-Kronast, Nils

AU - English, Joey D.

AU - Linfante, Italo

AU - Dabus, Guilherme

AU - Malisch, Timothy W.

AU - Marden, Franklin A.

AU - Bozorgchami, Hormozd

AU - Xavier, Andrew

AU - Rai, Ansaar T.

AU - Froehler, Micahel T.

AU - Badruddin, Aamir

AU - Nguyen, Thanh N.

AU - Taqi, Muhammad

AU - Abraham, Michael G.

AU - Janardhan, Vallabh

AU - Shaltoni, Hashem

AU - Novakovic, Roberta

AU - Yoo, Albert J.

AU - Chen, Peng R.

AU - Britz, Gavin W.

AU - Kaushal, Ritesh

AU - Nanda, Ashish

AU - Issa, Mohammad A.

AU - Nogueira, Raul G.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - BACKGROUND AND PURPOSE-: Previous work that predated the availability of the safer stent-retriever devices has suggested that general anesthesia (GA) may have a negative impact on outcomes in patients with acute ischemic stroke undergoing endovascular therapy. METHODS-: We reviewed demographic, clinical, procedural (GA versus local anesthesia [LA], etc), and site-adjudicated angiographic and clinical outcomes data from consecutive patients treated with the Solitaire FR device in the investigator-initiated North American SOLITAIRE Stent-Retriever Acute Stroke (NASA) Registry. The primary outcomes were 90-day modified Rankin Scale, mortality, and symptomatic intracranial hemorrhage. RESULTS-: A total of 281 patients from 18 centers were enrolled. GA was used in 69.8% (196/281) of patients. Baseline demographic and procedural factors were comparable between the LA and GA groups, except the former demonstrated longer time-to-groin puncture (395.4±254 versus 337.4±208 min; P=0.04), lower National Institutes of Health Stroke Scale (NIHSS; 16.2±5.8 versus 18.8±6.9; P=0.002), lower balloon-guide catheter usage (22.4% versus 49.2%; P=0.0001), and longer fluoroscopy times (39.5±33 versus 28±22.8 min; P=0.008). Recanalization (thrombolysis in cerebral infarction ?2b; 72.94% versus 73.6%; P=0.9) and rate of symptomatic intracranial hemorrhage (7.1% versus 11.2%; P=0.4) were similar but modified Rankin Scale ≤2 was achieved in more LA patients, 52.6% versus 35.6% (odds ratio, 1.4 [1.1-1.8]; P=0.01). In multivariate analysis, hypertension, NIHSS, unsuccessful revascularization, and GA use (odds ratio, 3.3 [1.6-7.1]; P=0.001) were associated with death. When only anterior circulation and elective GA patients were included, there was a persistent difference in good outcomes in favor of LA patients (50.7% versus 35.5%; odds ratio, 1.3 [1.01-1.6]; P=0.04). CONCLUSIONS-: The NASA Registry has demonstrated that clinical outcomes and survival are significantly better in patients treated with LA, without increased symptomatic intracranial hemorrhage risk. Future trials should prospectively evaluate the effect of GA on outcomes.

AB - BACKGROUND AND PURPOSE-: Previous work that predated the availability of the safer stent-retriever devices has suggested that general anesthesia (GA) may have a negative impact on outcomes in patients with acute ischemic stroke undergoing endovascular therapy. METHODS-: We reviewed demographic, clinical, procedural (GA versus local anesthesia [LA], etc), and site-adjudicated angiographic and clinical outcomes data from consecutive patients treated with the Solitaire FR device in the investigator-initiated North American SOLITAIRE Stent-Retriever Acute Stroke (NASA) Registry. The primary outcomes were 90-day modified Rankin Scale, mortality, and symptomatic intracranial hemorrhage. RESULTS-: A total of 281 patients from 18 centers were enrolled. GA was used in 69.8% (196/281) of patients. Baseline demographic and procedural factors were comparable between the LA and GA groups, except the former demonstrated longer time-to-groin puncture (395.4±254 versus 337.4±208 min; P=0.04), lower National Institutes of Health Stroke Scale (NIHSS; 16.2±5.8 versus 18.8±6.9; P=0.002), lower balloon-guide catheter usage (22.4% versus 49.2%; P=0.0001), and longer fluoroscopy times (39.5±33 versus 28±22.8 min; P=0.008). Recanalization (thrombolysis in cerebral infarction ?2b; 72.94% versus 73.6%; P=0.9) and rate of symptomatic intracranial hemorrhage (7.1% versus 11.2%; P=0.4) were similar but modified Rankin Scale ≤2 was achieved in more LA patients, 52.6% versus 35.6% (odds ratio, 1.4 [1.1-1.8]; P=0.01). In multivariate analysis, hypertension, NIHSS, unsuccessful revascularization, and GA use (odds ratio, 3.3 [1.6-7.1]; P=0.001) were associated with death. When only anterior circulation and elective GA patients were included, there was a persistent difference in good outcomes in favor of LA patients (50.7% versus 35.5%; odds ratio, 1.3 [1.01-1.6]; P=0.04). CONCLUSIONS-: The NASA Registry has demonstrated that clinical outcomes and survival are significantly better in patients treated with LA, without increased symptomatic intracranial hemorrhage risk. Future trials should prospectively evaluate the effect of GA on outcomes.

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