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Article: 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

TitleEffect 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
Authors
Campbell, Bruce C.V.van Zwam, Wim H.Goyal, MayankMenon, Bijoy K.Dippel, Diederik W.J.Demchuk, Andrew M.Bracard, SergeWhite, PhilipDávalos, AntoniMajoie, Charles B.L.M.van der Lugt, AadFord, Gary A.de la Ossa, Natalia PérezKelly, MichaelBourcier, RomainDonnan, Geoffrey A.Roos, Yvo B.W.E.M.Bang, Oh YoungNogueira, Raul G.Devlin, Thomas G.van den Berg, Lucie A.Burns, PaulCarpenter, JeffreyBerkhemer, Olvert A.Yavagal, Dileep R.Pereira, Vitor MendesDucrocq, XavierDixit, AnandQuesada, HelenaEpstein, JonathanDavis, Stephen M.Rubiera, MartaUrra, XabierMicard, EmilienLingsma, Hester F.Naggara, OlivierBrown, ScottGuillemin, FrancisMuir, Keith W.van Oostenbrugge, Robert J.Saver, Jeffrey L.Jovin, Tudor G.Hill, Michael D.Mitchell, Peter J.Fransen, Puck SSBeumer, DebbieYoo, Albert J.Schonewille, Wouter J.Vos, Jan AlbertNederkoorn, Paul J.Wermer, Marieke JHvan Walderveen, Marianne AAStaals, JulieHofmeijer, Jeannettevan Oostayen, Jacques A.Lycklama à Nijeholt, Geert J.Boiten, JelisBrouwer, Patrick A.Emmer, Bart J.de Bruijn, Sebastiaan F.van Dijk, Lukas C.Kappelle, JaapLo, Rob H.van Dijk, Ewoud J.de Vries, Joostde 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, OmidSchreuder, Tobien H.C.M.L.Heijboer, Roel J.J.Keizer, KoosTielbeek, Alexander V.den Hertog, Heleen M.Gerrits, Dick G.van den Berg-Vos, Renske M.Karas, Giorgos B.Steyerberg, Ewout W.Flach, ZwennekeMarquering, Henk A.Sprengers, Marieke E.S.Jenniskens, Sjoerd F.M.Beenen, Ludo F.M.van den Berg, RenéKoudstaal, Peter J.Brown, Martin M.Liebig, ThomasStijnen, TheoAndersson, TommyMattle, HeinrichWahlgren, Nilsvan der Heijden, EstherGhannouti, NazihaFleitour, NadineHooijenga, ImkePuppels, CorinaPellikaan, WilmaGeerling, AnnetLindl-Velema, Annemiekevan Vemde, Ginade Ridder, AnsGreebe, Pautde Bont-Stikkelbroeck, Joséde Meris, JokeJanssen, KirstenStruijk, WillyLicher, SilvanBoodt, NikkiRos, AdriaanVenema, EsmeeSlokkers, IlseGanpat, Raymie JayceMulder, MaximSaiedie, NawidHeshmatollah, AlisSchipperen, StefanieVinken, Stefanvan Boxtel, TiemenKoets, JeroenBoers, MerelSantos, EmilieBorst, JordiJansen, IvoKappelhof, ManonLucas, MaritGeuskens, RalphBarros, Renan SalesDobbe, RoelandCsizmadia, MarloesEesa, M.Ryckborst, K. J.Wright, M. R.Kamal, N. R.Andersen, L.Randhawa, P. A.Stewart, T.Patil, S.Minhas, P.Almekhlafi, M.Mishra, S.Clement, F.Sajobi, T.Shuaib, A.Roy, D.Frei, D. F.Sapkota, B.Rempel, J. L.Thornton, J.Williams, D.Tampieri, D.Poppe, A. Y.Dowlatshahi, D.Wong, J. H.Mitha, A. P.Subramaniam, S.Hull, G.Lowerison, M. W.Salluzzi, M.Maxwell, M.Lacusta, S.Drupals, E.Armitage, K.Barber, P. A.Smith, E. E.Morrish, W. F.Coutts, S. B.Derdeyn, C.Demaerschalk, B.Martin, R.Brant, R.Yu, Y.Willinsky, R. A.Weill, A.Kenney, C.Aram, H.Stys, P. K.Watson, T. W.Klein, G.Pearson, D.Couillard, P.Trivedi, A.Singh, D.Klourfeld, E.Imoukhuede, O.Nikneshan, D.Blayney, S.Reddy, R.Choi, P.Horton, M.Musuka, T.Dubuc, V.Field, T. S.Desai, J.Adatia, S.Alseraya, A.Nambiar, V.van Dijk, R.Newcommon, N. J.Schwindt, B.Butcher, K. S.Jeerakathil, T.Buck, B.Khan, K.Naik, S. S.Emery, D. J.Owen, R. J.Kotylak, T. B.Ashforth, R. A.Yeo, T. A.McNally, D.Siddiqui, M.Saqqur, M.Hussain, D.Kalashyan, H.Manosalva, A.Kate, M.Gioia, L.Hasan, S.Mohammad, A.Muratoglu, M.Cullen, A.Brennan, P.O'Hare, A.Looby, S.Hyland, D.Duff, S.McCusker, M.Hallinan, B.Lee, S.McCormack, J.Moore, A.O'Connor, M.Donegan, C.Brewer, L.Martin, A.Murphy, S.O'Rourke, K.Smyth, S.Kelly, P.Lynch, T.Daly, T.O'Brien, P.O'Driscoll, A.Martin, M.Collins, R.Coughlan, T.McCabe, D.O'Neill, D.Mulroy, M.Lynch, O.Walsh, T.O'Donnell, M.Galvin, T.Harbison, J.McElwaine, P.Mulpeter, K.McLoughlin, C.Reardon, M.Harkin, E.Dolan, E.Watts, M.Cunningham, N.Fallon, C.Gallagher, S.Cotter, P.Crowe, M.Doyle, R.Noone, I.Lapierre, M.Coté, V. A.Lanthier, S.Odier, C.Durocher, A.Raymond, J.Daneault, N.Deschaintre, Y.Jankowitz, B.Baxendell, L.Massaro, L.Jackson-Graves, C.Decesare, S.Porter, P.Armbruster, K.Adams, A.Billigan, J.Oakley, J.Ducruet, A.Jadhav, A.Giurgiutiu, D. 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S.Mandzia, J.Pelz, D.Crann, S.Fleming, L.Hesser, K.Beauchamp, B.Amato-Marzialli, B.Boulton, M.Lopez-Ojeda, P.Sharma, M.Lownie, S.Chan, R.Swartz, R.Howard, P.Golob, D.Gladstone, D.Boyle, K.Boulos, M.Hopyan, J.Yang, V.Da Costa, L.Holmstedt, C. A.Turk, A. S.Navarro, R.Jauch, E.Ozark, S.Turner, R.Phillips, S.Shankar, J.Jarrett, J.Gubitz, G.Maloney, W.Vandorpe, R.Schmidt, M.Heidenreich, J.Hunter, G.Whelan, R.Peeling, L.Hunter, A.Wiggam, I.Kerr, E.Watt, M.Fulton, A.Gordon, P.Rennie, I.Flynn, P.Smyth, G.O'Leary, S.Gentile, N.Linares, G.McNelis, P.Erkmen, K.Katz, P.Azizi, A.Weaver, M.Jungreis, C.Faro, S.Shah, P.Reimer, H.Kalugdan, V.Saposnik, G.Bharatha, A.Li, Y.Kostyrko, P.Marotta, T.Montanera, W.Sarma, D.Selchen, D.Spears, J.Heo, J. H.Jeong, K.Kim, D. J.Kim, B. M.Kim, Y. D.Song, D.Lee, K. J.Yoo, J.Rho, S.Lee, J.Jeon, P.Kim, K. H.Cha, J.Kim, S. J.Ryoo, S.Lee, M. J.Sohn, S. I.Kim, C. H.Ryu, H. G.Hong, J. H.Chang, H. W.Lee, C. Y.Rha, J.Churilov, LeonidYan, BernardDowling, RichardYassi, NawafOxley, Thomas J.Wu, Teddy Y.Silver, GabrielMcDonald, AmyMcCoy, RachaelKleinig, Timothy J.Scroop, RebeccaDewey, Helen M.Simpson, MarionBrooks, MarkCoulton, BronwynKrause, MartinHarrington, Timothy J.Steinfort, BrendanFaulder, KennethPriglinger, MiriamDay, SusanPhan, ThanhChong, WinstonHolt, MichaelChandra, Ronil V.Ma, HenryYoung, DennisWong, KittyWijeratne, TissaTu, HansMackay, ElizabethCelestino, SherisseBladin, Christopher F.Loh, Poh SienGilligan, AmandaRoss, ZofiaCoote, SkyeFrost, TanyaParsons, Mark W.Miteff, FerdinandLevi, Christopher R.Ang, TimothySpratt, NeilKaauwai, LaraBadve, MonicaRice, Henryde Villiers, LaetitiaMcGuinness, BenHope, AytonMoriarty, MauriceBennett, PatriciaWong, AndrewCoulthard, AlanLee, AndrewJannes, JimField, DeborahSharma, GaganSalinas, SimonCowley, EliseSnow, BarryKolbe, JohnStark, RichardKing, JohnMacdonnell, RichardAttia, JohnD'Este, CateDiener, Hans ChristophLevy, Elad I.Bonafé, AlainJahan, RezaAlbers, Gregory W.Cognard, ChristopheCohen, David J.Hacke, WernerJansen, OlavSiddiqui, Adnan H.von Kummer, RuüdigerSmith, WadeTurjman, FrancisHamilton, ScottChiacchierini, RichardAmar, ArunSanossian, NersesLoh, YinceHorev, A.Star, M.Hopkins, L. 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A.Aja, L.Serena, J.Cobo, E.Lees, Kennedy R.Arenillas, J.Roberts, R.Al-Ajlan, F.Zimmel, L.Patel, S.Martí-Fàbregas, J.Salvat-Plana, M.Anxionnat, RenéBaillot, Pierre AlexandreBarbier, CharlotteDerelle, Anne LaureLacour, Jean ChristopheRichard, SébastienSamson, YvesSourour, NaderBaronnet-Chauvet, FloreClarencon, FrédéricCrozier, SophieDeltour, SandrineDi Maria, FedericoLe Bouc, RaphaelLeger, AnneMutlu, GurkanRosso, CharlotteSzatmary, ZoltanYger, MarionZavanone, ChiaraBakchine, SergePierot, LaurentCaucheteux, NathalieEstrade, LaurentKadziolka, KrzysztofLeautaud, AlexandreRenkes, CélineSerre, IsabelleDesal, HubertGuillon, BenoîtBoutoleau-Bretonniere, ClaireDaumas-Duport, BenjaminDe Gaalon, SolèneDerkinderen, PascalEvain, SarahHerisson, FannyLaplaud, David AxelLebouvier, ThibaudLintia-Gaultier, AlinaPouclet-Courtemanche, HélèneRouaud, TiphaineRouaud Jaffrenou, ViolaineSchunck, AuréliaSevin-Allouet, MathieuToulgoat, FrederiqueWiertlewski, SandrineGauvrit, Jean YvesRonziere, ThomasCahagne, VincentFerre, Jean ChristophePinel, Jean FrançoisRaoult, HélèneMas, Jean LouisMeder, Jean FrançoisAl Najjar-Carpentier, Amen AdamBirchenall, JuliaBodiguel, EricCalvet, DavidDomigo, ValérieGodon-Hardy, SylvieGuiraud, VincentLamy, CatherineMajhadi, LoubnaMorin, LudovicTrystram, DenisTurc, GuillaumeBerge, JérômeSibon, IgorMenegon, PatriceBarreau, XavierRouanet, FrançoisDebruxelles, SabrinaKazadi, AnnabelleRenou, PaulineFleury, OlivierPasco-Papon, AnneDubas, FrédéricCaroff, JildazGodard Ducceschi, SophieHamon, Marie AurélieLecluse, AldericMarc, GuillaumeGiroud, MauriceRicolfi, FrédéricBejot, YannickChavent, AdrienGentil, ArnaudKazemi, ApollineOsseby, Guy VictorVoguet, CharlotteMahagne, Marie HélèneSedat, JacquesChau, YvesSuissa, LaurentLachaud, SylvainHoudart, EmmanuelStapf, ChristianBuffon Porcher, FrédériqueChabriat, HuguesGuedin, PierreHerve, DominiqueJouvent, EricMawet, JérômeSaint-Maurice, Jean PierreSchneble, Hans MartinNighoghossian, NorbertBerhoune, Nadia NawelBouhour, FrançoiseCho, Tae HeeDerex, LaurentFelix, SandraGervais-Bernard, HélèneGory, BenjaminManera, LuisMechtouff, LauraRitzenthaler, ThomasRiva, RobertoSalaris Silvio, FabrizioTilikete, CarolineBlanc, RaphaelObadia, MichaëlBartolini, Mario BrunoGueguen, AntoinePiotin, MichelPistocchi, SilviaRedjem, HocineDrouineau, JacquesNeau, Jean PhilippeGodeneche, GaelleLamy, MatthiasMarsac, EmiliaVelasco, StephaneClavelou, PierreChabert, EmmanuelBourgois, NathalieCornut-Chauvinc, CatherineFerrier, AnnaGabrillargues, JeanJean, BettyMarques, Anna RaquelVitello, NicolasDetante, OlivierBarbieux, MarianneBoubagra, KamelFavre Wiki, IsabelleGarambois, KatiaTahon, FlorenceAshok, VasdevCoskun, OguzhanRodesch, GeorgesLapergue, BertrandBourdain, FrédéricEvrard, SergeGraveleau, PhilippeDecroix, Jean PierreWang, AdrienSellal, FrançoisAhle, GuidoCarelli, GabrielaDugay, Marie HélèneGaultier, ClaudeLebedinsky, Ariel PabloLita, LaviniaMusacchio, Raul MarianoRenglewicz-Destuynder, CatherineTournade, AlainVuillemet, FrançisMontoro, Francisco MacianMounayer, CharbelFaugeras, FredericGimenez, LaetitiaLabach, CatherineLautrette, GéraldineDenier, ChristianSaliou, GuillaumeChassin, OlivierDussaule, ClaireMelki, ElsaOzanne, AugustinPuccinelli, FrancescoSachet, MarinaSarov, MarianaBonneville, Jean FrançoisMoulin, ThierryBiondi, AlessandraDe Bustos Medeiros, ElisabethVuillier, FabriceCourtheoux, PatrickViader, FaustoApoil-Brissard, MarionBataille, MathieuBonnet, Anne LaureCogez, JulienTouze, EmmanuelLeclerc, XavierLeys, DidierAggour, MohamedAguettaz, PierreBodenant, MarieCordonnier, CharlotteDeplanque, DominiqueGirot, MarieHenon, HildeKalsoum, ErwahLucas, ChristianPruvo, Jean PierreZuniga, PaoloBounolleau, PierreArteaga, CharlesFaivre, AnthonyBintner, MarcTournebize, PatriceCharlin, CyrilDarcel, FrançoiseGauthier-Lasalarie, PascaleJeremenko, MarciaMouton, ServaneZerlauth, Jean BaptisteHervé, DeramondHassan, HosseiniGaston, AndréBarral, Francis GuyGarnier, PierreBeaujeux, RémyWolff, ValérieHerbreteau, DenisDebiais, SéverineMurray, AliciaFreeman, JanetFord, IanMarkus, HughWardlaw, JoannaMolyneux, AndyRobinson, ThompsonLewis, SteffNorrie, JohnRobertson, FergusPerry, RichardCloud, GeoffreyClifton, AndrewMadigan, JeremyRoffe, ChristineNayak, SanjeevLobotesis, KyriakosSmith, CraigHerwadkar, AmitKandasamy, NagaGoddard, TonyBamford, JohnSubramanian, GaneshLenthall, RobLittleton, EdwardLamin, SalStorey, KelleyGhatala, RitaBanaras, AzraAeron-Thomas, JohnHazel, BathMaguire, HollyVeraque, EmeldaHarrison, LouiseKeshvara, RekhaCunningham, James
Issue Date2018
Citation
The Lancet Neurology, 2018, v. 17, n. 1, p. 47-53 How to Cite?
AbstractBackground 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 GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09–2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75–3·10, p<0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14–2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low. Interpretation Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons. Funding Medtronic.
Persistent Identifierhttp://hdl.handle.net/10722/325369
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2023 Impact Factor: 46.5
2023 SCImago Journal Rankings: 8.589
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dc.contributor.authorCoulthard, Alan-
dc.contributor.authorLee, Andrew-
dc.contributor.authorJannes, Jim-
dc.contributor.authorField, Deborah-
dc.contributor.authorSharma, Gagan-
dc.contributor.authorSalinas, Simon-
dc.contributor.authorCowley, Elise-
dc.contributor.authorSnow, Barry-
dc.contributor.authorKolbe, John-
dc.contributor.authorStark, Richard-
dc.contributor.authorKing, John-
dc.contributor.authorMacdonnell, Richard-
dc.contributor.authorAttia, John-
dc.contributor.authorD'Este, Cate-
dc.contributor.authorDiener, Hans Christoph-
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dc.contributor.authorBonafé, Alain-
dc.contributor.authorJahan, Reza-
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dc.contributor.authorCognard, Christophe-
dc.contributor.authorCohen, David J.-
dc.contributor.authorHacke, Werner-
dc.contributor.authorJansen, Olav-
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dc.contributor.authorvon Kummer, Ruüdiger-
dc.contributor.authorSmith, Wade-
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dc.contributor.authorBaillot, Pierre Alexandre-
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dc.contributor.authorLacour, Jean Christophe-
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dc.contributor.authorSourour, Nader-
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dc.contributor.authorCrozier, Sophie-
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dc.contributor.authorRouaud Jaffrenou, Violaine-
dc.contributor.authorSchunck, Aurélia-
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dc.contributor.authorToulgoat, Frederique-
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dc.contributor.authorRonziere, Thomas-
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dc.contributor.authorAl Najjar-Carpentier, Amen Adam-
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dc.contributor.authorRenou, Pauline-
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dc.contributor.authorCaroff, Jildaz-
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dc.contributor.authorHamon, Marie Aurélie-
dc.contributor.authorLecluse, Alderic-
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dc.contributor.authorKazemi, Apolline-
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dc.contributor.authorSuissa, Laurent-
dc.contributor.authorLachaud, Sylvain-
dc.contributor.authorHoudart, Emmanuel-
dc.contributor.authorStapf, Christian-
dc.contributor.authorBuffon Porcher, Frédérique-
dc.contributor.authorChabriat, Hugues-
dc.contributor.authorGuedin, Pierre-
dc.contributor.authorHerve, Dominique-
dc.contributor.authorJouvent, Eric-
dc.contributor.authorMawet, Jérôme-
dc.contributor.authorSaint-Maurice, Jean Pierre-
dc.contributor.authorSchneble, Hans Martin-
dc.contributor.authorNighoghossian, Norbert-
dc.contributor.authorBerhoune, Nadia Nawel-
dc.contributor.authorBouhour, Françoise-
dc.contributor.authorCho, Tae Hee-
dc.contributor.authorDerex, Laurent-
dc.contributor.authorFelix, Sandra-
dc.contributor.authorGervais-Bernard, Hélène-
dc.contributor.authorGory, Benjamin-
dc.contributor.authorManera, Luis-
dc.contributor.authorMechtouff, Laura-
dc.contributor.authorRitzenthaler, Thomas-
dc.contributor.authorRiva, Roberto-
dc.contributor.authorSalaris Silvio, Fabrizio-
dc.contributor.authorTilikete, Caroline-
dc.contributor.authorBlanc, Raphael-
dc.contributor.authorObadia, Michaël-
dc.contributor.authorBartolini, Mario Bruno-
dc.contributor.authorGueguen, Antoine-
dc.contributor.authorPiotin, Michel-
dc.contributor.authorPistocchi, Silvia-
dc.contributor.authorRedjem, Hocine-
dc.contributor.authorDrouineau, Jacques-
dc.contributor.authorNeau, Jean Philippe-
dc.contributor.authorGodeneche, Gaelle-
dc.contributor.authorLamy, Matthias-
dc.contributor.authorMarsac, Emilia-
dc.contributor.authorVelasco, Stephane-
dc.contributor.authorClavelou, Pierre-
dc.contributor.authorChabert, Emmanuel-
dc.contributor.authorBourgois, Nathalie-
dc.contributor.authorCornut-Chauvinc, Catherine-
dc.contributor.authorFerrier, Anna-
dc.contributor.authorGabrillargues, Jean-
dc.contributor.authorJean, Betty-
dc.contributor.authorMarques, Anna Raquel-
dc.contributor.authorVitello, Nicolas-
dc.contributor.authorDetante, Olivier-
dc.contributor.authorBarbieux, Marianne-
dc.contributor.authorBoubagra, Kamel-
dc.contributor.authorFavre Wiki, Isabelle-
dc.contributor.authorGarambois, Katia-
dc.contributor.authorTahon, Florence-
dc.contributor.authorAshok, Vasdev-
dc.contributor.authorCoskun, Oguzhan-
dc.contributor.authorRodesch, Georges-
dc.contributor.authorLapergue, Bertrand-
dc.contributor.authorBourdain, Frédéric-
dc.contributor.authorEvrard, Serge-
dc.contributor.authorGraveleau, Philippe-
dc.contributor.authorDecroix, Jean Pierre-
dc.contributor.authorWang, Adrien-
dc.contributor.authorSellal, François-
dc.contributor.authorAhle, Guido-
dc.contributor.authorCarelli, Gabriela-
dc.contributor.authorDugay, Marie Hélène-
dc.contributor.authorGaultier, Claude-
dc.contributor.authorLebedinsky, Ariel Pablo-
dc.contributor.authorLita, Lavinia-
dc.contributor.authorMusacchio, Raul Mariano-
dc.contributor.authorRenglewicz-Destuynder, Catherine-
dc.contributor.authorTournade, Alain-
dc.contributor.authorVuillemet, Françis-
dc.contributor.authorMontoro, Francisco Macian-
dc.contributor.authorMounayer, Charbel-
dc.contributor.authorFaugeras, Frederic-
dc.contributor.authorGimenez, Laetitia-
dc.contributor.authorLabach, Catherine-
dc.contributor.authorLautrette, Géraldine-
dc.contributor.authorDenier, Christian-
dc.contributor.authorSaliou, Guillaume-
dc.contributor.authorChassin, Olivier-
dc.contributor.authorDussaule, Claire-
dc.contributor.authorMelki, Elsa-
dc.contributor.authorOzanne, Augustin-
dc.contributor.authorPuccinelli, Francesco-
dc.contributor.authorSachet, Marina-
dc.contributor.authorSarov, Mariana-
dc.contributor.authorBonneville, Jean François-
dc.contributor.authorMoulin, Thierry-
dc.contributor.authorBiondi, Alessandra-
dc.contributor.authorDe Bustos Medeiros, Elisabeth-
dc.contributor.authorVuillier, Fabrice-
dc.contributor.authorCourtheoux, Patrick-
dc.contributor.authorViader, Fausto-
dc.contributor.authorApoil-Brissard, Marion-
dc.contributor.authorBataille, Mathieu-
dc.contributor.authorBonnet, Anne Laure-
dc.contributor.authorCogez, Julien-
dc.contributor.authorTouze, Emmanuel-
dc.contributor.authorLeclerc, Xavier-
dc.contributor.authorLeys, Didier-
dc.contributor.authorAggour, Mohamed-
dc.contributor.authorAguettaz, Pierre-
dc.contributor.authorBodenant, Marie-
dc.contributor.authorCordonnier, Charlotte-
dc.contributor.authorDeplanque, Dominique-
dc.contributor.authorGirot, Marie-
dc.contributor.authorHenon, Hilde-
dc.contributor.authorKalsoum, Erwah-
dc.contributor.authorLucas, Christian-
dc.contributor.authorPruvo, Jean Pierre-
dc.contributor.authorZuniga, Paolo-
dc.contributor.authorBounolleau, Pierre-
dc.contributor.authorArteaga, Charles-
dc.contributor.authorFaivre, Anthony-
dc.contributor.authorBintner, Marc-
dc.contributor.authorTournebize, Patrice-
dc.contributor.authorCharlin, Cyril-
dc.contributor.authorDarcel, Françoise-
dc.contributor.authorGauthier-Lasalarie, Pascale-
dc.contributor.authorJeremenko, Marcia-
dc.contributor.authorMouton, Servane-
dc.contributor.authorZerlauth, Jean Baptiste-
dc.contributor.authorHervé, Deramond-
dc.contributor.authorHassan, Hosseini-
dc.contributor.authorGaston, André-
dc.contributor.authorBarral, Francis Guy-
dc.contributor.authorGarnier, Pierre-
dc.contributor.authorBeaujeux, Rémy-
dc.contributor.authorWolff, Valérie-
dc.contributor.authorHerbreteau, Denis-
dc.contributor.authorDebiais, Séverine-
dc.contributor.authorMurray, Alicia-
dc.contributor.authorFreeman, Janet-
dc.contributor.authorFord, Ian-
dc.contributor.authorMarkus, Hugh-
dc.contributor.authorWardlaw, Joanna-
dc.contributor.authorMolyneux, Andy-
dc.contributor.authorRobinson, Thompson-
dc.contributor.authorLewis, Steff-
dc.contributor.authorNorrie, John-
dc.contributor.authorRobertson, Fergus-
dc.contributor.authorPerry, Richard-
dc.contributor.authorCloud, Geoffrey-
dc.contributor.authorClifton, Andrew-
dc.contributor.authorMadigan, Jeremy-
dc.contributor.authorRoffe, Christine-
dc.contributor.authorNayak, Sanjeev-
dc.contributor.authorLobotesis, Kyriakos-
dc.contributor.authorSmith, Craig-
dc.contributor.authorHerwadkar, Amit-
dc.contributor.authorKandasamy, Naga-
dc.contributor.authorGoddard, Tony-
dc.contributor.authorBamford, John-
dc.contributor.authorSubramanian, Ganesh-
dc.contributor.authorLenthall, Rob-
dc.contributor.authorLittleton, Edward-
dc.contributor.authorLamin, Sal-
dc.contributor.authorStorey, Kelley-
dc.contributor.authorGhatala, Rita-
dc.contributor.authorBanaras, Azra-
dc.contributor.authorAeron-Thomas, John-
dc.contributor.authorHazel, Bath-
dc.contributor.authorMaguire, Holly-
dc.contributor.authorVeraque, Emelda-
dc.contributor.authorHarrison, Louise-
dc.contributor.authorKeshvara, Rekha-
dc.contributor.authorCunningham, James-
dc.date.accessioned2023-02-27T07:32:18Z-
dc.date.available2023-02-27T07:32:18Z-
dc.date.issued2018-
dc.identifier.citationThe Lancet Neurology, 2018, v. 17, n. 1, p. 47-53-
dc.identifier.issn1474-4422-
dc.identifier.urihttp://hdl.handle.net/10722/325369-
dc.description.abstractBackground 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 GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09–2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75–3·10, p<0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14–2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low. Interpretation Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons. Funding Medtronic.-
dc.languageeng-
dc.relation.ispartofThe Lancet Neurology-
dc.titleEffect 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-
dc.typeArticle-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/S1474-4422(17)30407-6-
dc.identifier.pmid29263006-
dc.identifier.scopuseid_2-s2.0-85039561512-
dc.identifier.volume17-
dc.identifier.issue1-
dc.identifier.spage47-
dc.identifier.epage53-
dc.identifier.eissn1474-4465-
dc.identifier.isiWOS:000418570500022-

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