The Functional Prognosis of Rescue Conscious Sedation During Mechanical Thrombectomy on Patients with Acute Anterior Circulation Ischemic Stroke: A Single-Center Retrospective Study

Shilin Li; Yu Zhang; Xiaobo Zhang; Gejuan Zhang; Nannan Han; Haojun Ma; Hanming Ge; Yong Zhao; Leshi Zhang; Yanfei Wang; Wenzhen Shi; Xiaojuan Ma; Yizhuo Tian; Yixuan Xiao; Yinuo Niu; Lin Qiao; Mingze Chang

doi:10.1007/s40120-023-00528-y

The Functional Prognosis of Rescue Conscious Sedation During Mechanical Thrombectomy on Patients with Acute Anterior Circulation Ischemic Stroke: A Single-Center Retrospective Study

Neurol Ther. 2023 Oct;12(5):1777-1789. doi: 10.1007/s40120-023-00528-y. Epub 2023 Aug 2.

Authors

Shilin Li¹, Yu Zhang², Xiaobo Zhang², Gejuan Zhang¹, Nannan Han¹, Haojun Ma¹, Hanming Ge¹, Yong Zhao¹, Leshi Zhang¹, Yanfei Wang¹, Wenzhen Shi³, Xiaojuan Ma³, Yizhuo Tian⁴, Yixuan Xiao⁴, Yinuo Niu⁴, Lin Qiao⁵, Mingze Chang⁶

Affiliations

¹ Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an, 710069, China.
² The College of Life Sciences, Northwest University, Xi'an, China.
³ Xi'an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, Medical Research Center, The Aliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an, China.
⁴ Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, Xi'an, China.
⁵ Department of Anesthesiology, Xi'an No.5 Hospital, Xi'an, China.
⁶ Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an, 710069, China. changmingze191@163.com.

Abstract

Introduction: Based on real-world case data, this study intends to explore and analyze the impact of rescue conscious sedation (CS) on the clinical outcomes of patients with anterior circulation acute ischemic stroke (AIS) receiving mechanical thrombectomy (MT).

Methods: This retrospective study enrolled patients with anterior circulation AIS who received MT and were treated with either single local anesthesia (LA) or rescue CS during MT between January 2018 and October 2021. We used univariate and multivariate logistic regression methods to compare the impact of LA and CS on the clinical outcomes of patients with AIS who received MT, including the mRS at 90 days, the incidence of poststroke pneumonia (PSP), the incidence of symptomatic intracranial cerebral hemorrhage (sICH), and the mortality rate.

Results: We reviewed 314 patient cases with AIS who received MT. Of all patients, 164 met our search criteria. Eighty-nine patients received LA, and 75 patients received rescue CS. There was no significant difference between the two groups in the 90-day good prognosis (45.3% vs. 51.7%, p = 0.418) and mortality (17.3% vs. 22.5%, p = 0.414). Compared with the LA group, the incidence of postoperative pneumonia in the rescue CS group (44% vs. 25.8%, p = 0.015) was more significant. Multivariate stepwise logistic regression analysis revealed that intraoperative remedial CS was independently associated with PSP following MT. In a subgroup analysis, rescue CS was found to significantly increase the incidence of PSP in patients with dysphagia (OR = 7.307, 95% CI 2.144-24.906, p = 0.001). As the severity of the National Institutes of Health Stroke Scale (NIHSS) increased, intraoperative rescue CS was found to increase the risk of PSP (OR = 1.155, 95% CI 1.034-1.290, p = 0.011) by 5.1% compared to that of LA (OR = 1.104, 95% CI 1.013-1.204, p = 0.024).

Conclusion: Compared to LA, rescue CS during MT does not significantly improve the 90 days of good prognosis and reduce the incidence of sICH and mortality in patients with anterior circulation AIS. However, it has a significantly increased risk of poststroke pneumonia (PSP), particularly in patients with dysphagia.

Keywords: Acute anterior circulation ischemic stroke; Local anesthesia; Mechanical thrombectomy; Poststroke pneumonia; Rescue conscious sedation.

Abstract

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