Viva Levee, Mariarosaria Valente, Francesco Bax, Liqun Zhang, Simona Sacco, Matteo Foschi, Raffaele Ornello, Katherine Chulack, Emma Marchong, Fahad Sheikh, Feras Fayez, Caterina Del Regno, Mohammed Aggour, Massimo Sponza, Francesco Toraldo, Razan Algazlan, Kyriakos Lobotesis, Daniele Bagatto, Nina Mansoor, Dheeraj Kalladka, Vladimir Gavrilovic, Cristian Deana, Flavio Bassi, Berry Stewart, Gian Luigi Gigli, Soma Banerjee, Giovanni Merlino, Lucio D'Anna
{"title":"对前循环大血管闭塞接受机械血栓切除术治疗的非老年患者采用不同麻醉技术的效果:反概率加权分析","authors":"Viva Levee, Mariarosaria Valente, Francesco Bax, Liqun Zhang, Simona Sacco, Matteo Foschi, Raffaele Ornello, Katherine Chulack, Emma Marchong, Fahad Sheikh, Feras Fayez, Caterina Del Regno, Mohammed Aggour, Massimo Sponza, Francesco Toraldo, Razan Algazlan, Kyriakos Lobotesis, Daniele Bagatto, Nina Mansoor, Dheeraj Kalladka, Vladimir Gavrilovic, Cristian Deana, Flavio Bassi, Berry Stewart, Gian Luigi Gigli, Soma Banerjee, Giovanni Merlino, Lucio D'Anna","doi":"10.1177/23969873241293009","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>There is a lack of evidence for the optimal type of anesthesia technique in patients ⩾ 90 years with acute ischemic stroke undergoing mechanical thrombectomy (MT) as this subgroup of patients was often excluded or under-represented in previous trials. We aimed to compare outcomes between general anesthesia (GA) and non-GA techniques in patients ⩾ 90 years with large vessel occlusion (LVO) undergoing MT.</p><p><strong>Patients and methods: </strong>Our study included patients ⩾ 90 years with anterior circulation LVO, NIHSS ⩾ 6, ASPECTS ⩾ 5 consecutively treated with MT within 6 h after stroke onset in three thrombectomy capable centers between January 1st, 2016 and March 30th, 2023. Inverse probability weighting (IPW) was used to reduce bias by indication of the anesthesia type on study outcomes. We used a weighted ordinal robust logistic regression analysis to explore the primary outcome of modified Rankin Scale (mRS) shift at 90 days in GA versus non-GA treated patients. Secondary outcomes included 90-day mortality, symptomatic intracranial hemorrhage (sICH) and TICI score of 2b, 2c, or 3.</p><p><strong>Results: </strong>We included 139 patients ⩾ 90 years treated with MT, 62 were in GA group and 77 in non-GA group. There was a significant shift for worse mRS scores at 90-day in non-GA treated patients (cOR 3.65, 95% CI 1.77-7.77, <i>p</i> = 0.001). The weighted logistic regression showed that non-GA technique was an independent predictor of 90-day mortality (OR 7.49, 95% CI 2.00-28.09; <i>p</i> = 0.003).</p><p><strong>Conclusion: </strong>Our study indicated that nonagenarians with acute ischemic stroke treated with MT without GA have a worse prognosis than their counterparts undergoing MT with GA. 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We aimed to compare outcomes between general anesthesia (GA) and non-GA techniques in patients ⩾ 90 years with large vessel occlusion (LVO) undergoing MT.</p><p><strong>Patients and methods: </strong>Our study included patients ⩾ 90 years with anterior circulation LVO, NIHSS ⩾ 6, ASPECTS ⩾ 5 consecutively treated with MT within 6 h after stroke onset in three thrombectomy capable centers between January 1st, 2016 and March 30th, 2023. Inverse probability weighting (IPW) was used to reduce bias by indication of the anesthesia type on study outcomes. We used a weighted ordinal robust logistic regression analysis to explore the primary outcome of modified Rankin Scale (mRS) shift at 90 days in GA versus non-GA treated patients. Secondary outcomes included 90-day mortality, symptomatic intracranial hemorrhage (sICH) and TICI score of 2b, 2c, or 3.</p><p><strong>Results: </strong>We included 139 patients ⩾ 90 years treated with MT, 62 were in GA group and 77 in non-GA group. 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引用次数: 0
摘要
导言:对于接受机械性血栓切除术(MT)的 90 岁以上急性缺血性卒中患者,目前尚缺乏最佳麻醉技术类型的证据,因为在之前的试验中,该亚组患者往往被排除在外或代表性不足。我们的目的是比较全身麻醉(GA)和非GA技术对接受机械取栓术的⩾90岁大血管闭塞(LVO)患者的治疗效果:我们的研究纳入了2016年1月1日至2023年3月30日期间在三家血栓切除术中心连续接受MT治疗的前循环LVO患者,年龄⩾90岁,NIHSS ⩾6,ASPECTS ⩾5,卒中发生后6小时内接受MT治疗。我们采用了反概率加权法(IPW)来减少麻醉类型对研究结果的影响。我们采用加权顺序稳健逻辑回归分析来探讨GA与非GA治疗患者90天后的改良Rankin量表(mRS)变化这一主要结果。次要结果包括 90 天死亡率、症状性颅内出血(sICH)和 TICI 评分 2b、2c 或 3:我们纳入了 139 名接受 MT 治疗的 90 岁以上患者,其中 62 人属于 GA 组,77 人属于非 GA 组。非GA治疗患者90天后的mRS评分明显变差(cOR 3.65,95% CI 1.77-7.77,p = 0.001)。加权逻辑回归显示,非 GA 技术是 90 天死亡率的独立预测因素(OR 7.49,95% CI 2.00-28.09;P = 0.003):我们的研究表明,与接受MT治疗的非老年急性缺血性卒中患者相比,接受MT治疗的非老年急性缺血性卒中患者的预后较差。有必要在更大的群体中开展进一步研究,以评估这一患者群体的最佳麻醉类型。
Outcomes of different anesthesia techniques in nonagenarians treated with mechanical thrombectomy for anterior circulation large vessel occlusion: An inverse probability weighting analysis.
Introduction: There is a lack of evidence for the optimal type of anesthesia technique in patients ⩾ 90 years with acute ischemic stroke undergoing mechanical thrombectomy (MT) as this subgroup of patients was often excluded or under-represented in previous trials. We aimed to compare outcomes between general anesthesia (GA) and non-GA techniques in patients ⩾ 90 years with large vessel occlusion (LVO) undergoing MT.
Patients and methods: Our study included patients ⩾ 90 years with anterior circulation LVO, NIHSS ⩾ 6, ASPECTS ⩾ 5 consecutively treated with MT within 6 h after stroke onset in three thrombectomy capable centers between January 1st, 2016 and March 30th, 2023. Inverse probability weighting (IPW) was used to reduce bias by indication of the anesthesia type on study outcomes. We used a weighted ordinal robust logistic regression analysis to explore the primary outcome of modified Rankin Scale (mRS) shift at 90 days in GA versus non-GA treated patients. Secondary outcomes included 90-day mortality, symptomatic intracranial hemorrhage (sICH) and TICI score of 2b, 2c, or 3.
Results: We included 139 patients ⩾ 90 years treated with MT, 62 were in GA group and 77 in non-GA group. There was a significant shift for worse mRS scores at 90-day in non-GA treated patients (cOR 3.65, 95% CI 1.77-7.77, p = 0.001). The weighted logistic regression showed that non-GA technique was an independent predictor of 90-day mortality (OR 7.49, 95% CI 2.00-28.09; p = 0.003).
Conclusion: Our study indicated that nonagenarians with acute ischemic stroke treated with MT without GA have a worse prognosis than their counterparts undergoing MT with GA. Further studies in larger cohorts are warranted to evaluate the optimal type of anesthesia in this patient population.
期刊介绍:
Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.