| Title: |
Association of anesthesia strategies with outcomes in endovascular treatment for distal and medium vessel occlusions:A propensity score-matched analysis of the MR CLEAN registry and meta-analysis |
| Authors: |
Doheim, Mohamed F.; Knapen, Robrecht R.M.M.; Dippel, Diederik W.J.; Staals, Julie; Hofmeijer, Jeannette; van Es, Adriaan C.G.M.; Coutinho, Jonathan M.; van der Leij, Christiaan; Nogueira, Raul G.; van Oostenbrugge, Robert J.; van Zwam, Wim H. |
| Source: |
Doheim, M F, Knapen, R R M M, Dippel, D W J, Staals, J, Hofmeijer, J, van Es, A C G M, Coutinho, J M, van der Leij, C, Nogueira, R G, van Oostenbrugge, R J & van Zwam, W H 2026, 'Association of anesthesia strategies with outcomes in endovascular treatment for distal and medium vessel occlusions : A propensity score-matched analysis of the MR CLEAN registry and meta-analysis', European Stroke Journal, vol. 11, no. 1, 23969873251352406. https://doi.org/10.1093/esj/23969873251352406 |
| Publication Year: |
2026 |
| Description: |
BACKGROUND: Recent trials did not demonstrate the benefit of endovascular therapy (EVT) for distal or medium vessel occlusions (DMVOs), raising questions about factors influencing outcomes. Anesthesia choice may play a role, yet its impact remains unclear. This study assessed general anesthesia (GA) versus non-GA in EVT for DMVOs, evaluating procedural, functional, and safety outcomes. PATIENTS AND METHODS: Patients undergoing EVT for AIS due to anterior DMVOs in the middle cerebral artery (MCA-M2, M3, M4) and anterior cerebral artery (ACA-A1, A2, A3) from the MR CLEAN registry between March 2014 and December 2018 were included. They were stratified into GA and non-GA groups, with propensity score matching employed to adjust for differences in baseline risk. Primary outcomes included functional outcomes at 90 days, assessed by ordinal regression analysis of modified Rankin Scale (mRS) scores at 90 days, and recanalization rates measured by Thrombolysis in Cerebral Infarction (TICI) scores. Secondary outcomes included dichotomized mRS scores, death at 90 days, and symptomatic intracranial hemorrhage (sICH). A systematic review and meta-analysis of relevant DMVO studies with a random effects model was performed. This study was registered with PROSPERO (CRD42024607294). RESULTS: Among 5193 patients in the registry, 657 were eligible for our study, with 506 in the non-GA group, and 151 in the GA group. The median age was 73 years (IQR 64-81) in the non-GA group and 73 years (IQR 61-80) in the GA group (p = 0.35). The proportion of male patients was 50.2% in the non-GA group and 57.0% in the GA group (p = 0.15). In the matched cohort (n = 170), recanalization rates were higher in the GA group compared to the non-GA group (excellent recanalization rates (TICI2c/3): 61.0% vs 32.1%; OR 3.31, 95% CI (1.74-6.29), p < 0.001). There were no significant differences in the overall distribution of functional outcomes at 90 days (common OR 0.93, 95% CI (0.54-1.56), p = 0.77). Mortality was comparable between groups (34.1% vs ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| ISSN: |
2396-9873; 2396-9881 |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/41614488; info:eu-repo/semantics/altIdentifier/pissn/2396-9873; info:eu-repo/semantics/altIdentifier/eissn/2396-9881 |
| DOI: |
10.1093/esj/23969873251352406 |
| Availability: |
https://pure.eur.nl/en/publications/b69ad7ef-e29d-4cd1-b441-a40fcf0bc810; https://doi.org/10.1093/esj/23969873251352406; https://pure.eur.nl/ws/files/226175991/Association_of_anesthesia_strategies_with_outcomes_in_endovascular_treatment_for_distal_and_medium_vessel_occlusions.pdf; https://www.scopus.com/pages/publications/105012956019 |
| Rights: |
info:eu-repo/semantics/openAccess ; http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.871B0EC4 |
| Database: |
BASE |