Title :

Outcomes After Endovascular Therapy With Procedural Sedation vs General Anesthesia in Patients With Acute Ischemic Stroke: The AMETIS Randomized Clinical Trial.

Author(s) :

Chabanne, Russell [Auteur]
Service Anésthésie et Réanimation [CHU Clermont-Ferrand]
Geeraerts, Thomas [Auteur]
Centre Hospitalier Universitaire de Toulouse [CHU Toulouse]
Begard, Marc [Auteur]
CHU Clermont-Ferrand
Balança, Baptiste [Auteur]
Hospices Civils de Lyon [HCL]
Rapido, Francesco [Auteur]
Hôpital Gui de Chauliac [CHU Montpellier]
Degos, Vincent [Auteur]
CHU Pitié-Salpêtrière [AP-HP]
Tavernier, Benoit [Auteur]
METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
Molliex, Serge [Auteur]
Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] [CHU ST-E]
Velly, Lionel [Auteur]
Hôpital de la Timone [CHU - APHM] [TIMONE]
Verdonk, Franck [Auteur]
CHU Saint-Antoine [AP-HP]
Lukaszewicz, Anne-Claire [Auteur]
Hospices Civils de Lyon [HCL]
Perrigault, Pierre-François [Auteur]
Centre Hospitalier Régional Universitaire [Montpellier] [CHRU Montpellier]
Albucher, Jean-François [Auteur]
Centre Hospitalier Universitaire de Toulouse [CHU Toulouse]
Cognard, Christophe [Auteur]
Centre Hospitalier Universitaire de Toulouse [CHU Toulouse]
Guyot, Adrien [Auteur]
Service Anésthésie et Réanimation [CHU Clermont-Ferrand]
Fernandez, Charlotte [Auteur]
CHU Clermont-Ferrand
Masgrau, Aurélie [Auteur]
CHU Clermont-Ferrand
Moreno, Ricardo [Auteur]
CHU Clermont-Ferrand
Ferrier, Anna [Auteur]
CHU Clermont-Ferrand
Jaber, Samir [Auteur]
Centre Hospitalier Régional Universitaire [Montpellier] [CHRU Montpellier]
Bazin, Jean-Etienne [Auteur]
Service Anésthésie et Réanimation [CHU Clermont-Ferrand]
Pereira, Bruno [Auteur]
CHU Clermont-Ferrand
Futier, Emmanuel [Auteur]
CHU Clermont-Ferrand
Génétique, Reproduction et Développement [GReD]

Journal title :

JAMA neurology

Abbreviated title :

JAMA Neurol

Publication date :

2023-04-04

ISSN :

2168-6157

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Importance General anesthesia and procedural sedation are common practice for mechanical thrombectomy in acute ischemic stroke. However, risks and benefits of each strategy are unclear. Objective To determine whether ...
Show more >Importance General anesthesia and procedural sedation are common practice for mechanical thrombectomy in acute ischemic stroke. However, risks and benefits of each strategy are unclear. Objective To determine whether general anesthesia or procedural sedation for anterior circulation large-vessel occlusion acute ischemic stroke thrombectomy are associated with a difference in periprocedural complications and 3-month functional outcome. Design, Setting, and Participants This open-label, blinded end point randomized clinical trial was conducted between August 2017 and February 2020, with final follow-up in May 2020, at 10 centers in France.Adults with occlusion of the intracranial internal carotid artery and/or the proximal middle cerebral artery treated with thrombectomy were enrolled. Interventions Patients were assigned to receive general anesthesia with tracheal intubation (n = 135) or procedural sedation (n = 138). Main Outcomes and Measures The prespecified primary composite outcome was functional independence (a score of 0 to 2 on the modified Rankin Scale, which ranges from 0 [no neurologic disability] to 6 [death]) at 90 days and absence of major periprocedural complications (procedure-related serious adverse events, pneumonia, myocardial infarction, cardiogenic acute pulmonary edema, or malignant stroke) at 7 days. Results Among 273 patients evaluable for the primary outcome in the modified intention-to-treat population, 142 (52.0%) were women, and the mean (SD) age was 71.6 (13.8) years. The primary outcome occurred in 38 of 135 patients (28.2%) assigned to general anesthesia and in 50 of 138 patients (36.2%) assigned to procedural sedation (absolute difference, 8.1 percentage points; 95% CI, −2.3 to 19.1; P = .15). At 90 days, the rate of patients achieving functional independence was 33.3% (45 of 135) with general anesthesia and 39.1% (54 of 138) with procedural sedation (relative risk, 1.18; 95% CI, 0.86-1.61; P = .32). The rate of patients without major periprocedural complications at 7 days was 65.9% (89 of 135) with general anesthesia and 67.4% (93 of 138) with procedural sedation (relative risk, 1.02; 95% CI, 0.86-1.21; P = .80). Conclusions and Relevance In patients treated with mechanical thrombectomy for anterior circulation acute ischemic stroke, general anesthesia and procedural sedation were associated with similar rates of functional independence and major periprocedural complications.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
CHU Lille

Collections :

• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694

Submission date :

2023-11-15T02:15:10Z
2024-03-28T09:42:56Z