J Stroke.  2023 Sep;25(3):399-408. 10.5853/jos.2023.00318.

Anesthetic Management and Outcomes of Endovascular Treatment of Basilar Artery Occlusion: Results From the ATTENTION Registry

• Tao C
• Yuan G
• Xu P
• Wang H
• Zhou P
• Yi T
• Li K
• Cui T
• Gao J
• Li R
• Sun J
• Zhang C
• Wang L
• Liu T
• Song J
• Yin Y
• Nguyen TN
• Li Q
• Hu W

• KMID: 2546441
• DOI: http://doi.org/10.5853/jos.2023.00318

Abstract

Background and Purpose
To examine the clinical and safety outcomes after endovascular treatment (EVT) for acute basilar artery occlusion (BAO) with different anesthetic modalities.
Methods
This was a retrospective analysis using data from the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) registry. Patients were divided into two groups defined by anesthetic modality performed during EVT: general anesthesia (GA) or non-general anesthesia (non-GA). The association between anesthetic management and clinical outcomes was evaluated in a propensity score matched (PSM) cohort and an inverse probability of treatment weighting (IPTW) cohort to adjust for imbalances between the two groups.
Results
Our analytic sample included 1,672 patients from 48 centers. The anesthetic modality was GA in 769 (46.0%) and non-GA in 903 (54.0%) patients. In our primary analysis with the PSM-based cohort, non-GA was comparable to GA concerning the primary outcome (adjusted common odds ratio [acOR], 1.01; 95% confidence interval [CI], 0.82 to 1.25; P=0.91). Mortality at 90 days was 38.4% in the GA group and 35.8% in the non-GA group (adjusted risk ratio, 0.95; 95% CI, 0.83 to 1.08; P=0.44). In our secondary analysis with the IPTW-based cohort, the anesthetic modality was significantly associated with the distribution of modified Rankin Scale at 90 days (acOR: 1.45 [95% CI: 1.20 to 1.75]).
Conclusion
In this nationally-representative observational study, acute ischemic stroke patients due to BAO undergoing EVT without GA had similar clinical and safety outcomes compared with patients treated with GA. These findings provide the basis for large-scale randomized controlled trials to test whether anesthetic management provides meaningful clinical effects for patients undergoing EVT.

Keyword

Stroke; Endovascular treatment; Basilar artery occlusion; Anesthetic management

Figure

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  Figure 1. Distribution of the mRS score in patients who received non-GA vs. GA. mRS, modified Rankin Scale; GA, general anesthesia; PSM, propensity score matched.

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  Figure 2. Subgroup analyses in patients of the ATTENTION BAO registry undergoing GA vs. non-GA in the PSM cohort. A forest plot shows the difference in the primary clinical outcome (adjusted common odds ratio indicating the odds of improvement of one point on the modified Rankin Scale at 90 days toward better outcome, analyzed using ordinal logistic regression) between GA and non-GA group. GA, general anesthesia; PSM, propensity score matched; CI, confidence interval; AF, atrial fibrillation; NIHSS, National Institutes of Health Stroke Scale; GCS, Glasgow Coma Scale; pc-ASPECTS, posterior circulation Acute Stroke Prognosis Early Computed Tomography Score; ATTENTION, Endovascular Treatment for Acute Basilar Artery Occlusion; BAO, basilar artery occlusion.

Reference

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