Hypotension during endovascular treatment under general anesthesia for acute ischemic stroke.
<h4>Objective</h4>The effect of anesthetic management (general anesthesia [GA], conscious sedation, or local anesthesia) on functional outcome and the role of blood pressure management during endovascular treatment (EVT) for acute ischemic stroke is under debate. We aimed to determine wh...
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Public Library of Science (PLoS)
2021
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oai:doaj.org-article:ed7f2e4496a548f9ab41b2bfadeb2f212021-12-02T20:10:15ZHypotension during endovascular treatment under general anesthesia for acute ischemic stroke.1932-620310.1371/journal.pone.0249093https://doaj.org/article/ed7f2e4496a548f9ab41b2bfadeb2f212021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0249093https://doaj.org/toc/1932-6203<h4>Objective</h4>The effect of anesthetic management (general anesthesia [GA], conscious sedation, or local anesthesia) on functional outcome and the role of blood pressure management during endovascular treatment (EVT) for acute ischemic stroke is under debate. We aimed to determine whether hypotension during EVT under GA is associated with functional outcome at 90 days.<h4>Methods</h4>We retrospectively collected data from patients with a proximal intracranial occlusion of the anterior circulation treated with EVT under GA. The primary outcome was the distribution on the modified Rankin Scale at 90 days. Hypotension was defined using two thresholds: a mean arterial pressure (MAP) of 70 mm Hg and a MAP 30% below baseline MAP. To quantify the extent and duration of hypotension, the area under the threshold (AUT) was calculated using both thresholds.<h4>Results</h4>Of the 366 patients included, procedural hypotension was observed in approximately half of them. The occurrence of hypotension was associated with poor functional outcome (MAP <70 mm Hg: adjusted common odds ratio [acOR], 0.57; 95% confidence interval [CI], 0.35-0.94; MAP decrease ≥30%: acOR, 0.76; 95% CI, 0.48-1.21). In addition, an association was found between the number of hypotensive periods and poor functional outcome (MAP <70 mm Hg: acOR, 0.85 per period increase; 95% CI, 0.73-0.99; MAP decrease ≥30%: acOR, 0.90 per period; 95% CI, 0.78-1.04). No association existed between AUT and functional outcome (MAP <70 mm Hg: acOR, 1.000 per 10 mm Hg*min increase; 95% CI, 0.998-1.001; MAP decrease ≥30%: acOR, 1.000 per 10 mm Hg*min; 95% CI, 0.999-1.000).<h4>Conclusions</h4>Occurrence of procedural hypotension and an increase in number of procedural hypotensive periods were associated with poor functional outcome, whereas the extent and duration of hypotension were not. Randomized clinical trials are needed to confirm our hypothesis that hypotension during EVT under GA has detrimental effects.Sabine L ColletteMaarten UyttenboogaartNoor SamuelsIrene C van der SchaafH Bart van der WorpGert Jan R LuijckxAllart M VenemaMarko M SahinovicRudi A J O DierckxHester F LingsmaTeus H KappenReinoud P H BokkersMR CLEAN Registry InvestigatorsPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0249093 (2021) |
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| spellingShingle |
Medicine R Science Q Sabine L Collette Maarten Uyttenboogaart Noor Samuels Irene C van der Schaaf H Bart van der Worp Gert Jan R Luijckx Allart M Venema Marko M Sahinovic Rudi A J O Dierckx Hester F Lingsma Teus H Kappen Reinoud P H Bokkers MR CLEAN Registry Investigators Hypotension during endovascular treatment under general anesthesia for acute ischemic stroke. |
| description |
<h4>Objective</h4>The effect of anesthetic management (general anesthesia [GA], conscious sedation, or local anesthesia) on functional outcome and the role of blood pressure management during endovascular treatment (EVT) for acute ischemic stroke is under debate. We aimed to determine whether hypotension during EVT under GA is associated with functional outcome at 90 days.<h4>Methods</h4>We retrospectively collected data from patients with a proximal intracranial occlusion of the anterior circulation treated with EVT under GA. The primary outcome was the distribution on the modified Rankin Scale at 90 days. Hypotension was defined using two thresholds: a mean arterial pressure (MAP) of 70 mm Hg and a MAP 30% below baseline MAP. To quantify the extent and duration of hypotension, the area under the threshold (AUT) was calculated using both thresholds.<h4>Results</h4>Of the 366 patients included, procedural hypotension was observed in approximately half of them. The occurrence of hypotension was associated with poor functional outcome (MAP <70 mm Hg: adjusted common odds ratio [acOR], 0.57; 95% confidence interval [CI], 0.35-0.94; MAP decrease ≥30%: acOR, 0.76; 95% CI, 0.48-1.21). In addition, an association was found between the number of hypotensive periods and poor functional outcome (MAP <70 mm Hg: acOR, 0.85 per period increase; 95% CI, 0.73-0.99; MAP decrease ≥30%: acOR, 0.90 per period; 95% CI, 0.78-1.04). No association existed between AUT and functional outcome (MAP <70 mm Hg: acOR, 1.000 per 10 mm Hg*min increase; 95% CI, 0.998-1.001; MAP decrease ≥30%: acOR, 1.000 per 10 mm Hg*min; 95% CI, 0.999-1.000).<h4>Conclusions</h4>Occurrence of procedural hypotension and an increase in number of procedural hypotensive periods were associated with poor functional outcome, whereas the extent and duration of hypotension were not. Randomized clinical trials are needed to confirm our hypothesis that hypotension during EVT under GA has detrimental effects. |
| format |
article |
| author |
Sabine L Collette Maarten Uyttenboogaart Noor Samuels Irene C van der Schaaf H Bart van der Worp Gert Jan R Luijckx Allart M Venema Marko M Sahinovic Rudi A J O Dierckx Hester F Lingsma Teus H Kappen Reinoud P H Bokkers MR CLEAN Registry Investigators |
| author_facet |
Sabine L Collette Maarten Uyttenboogaart Noor Samuels Irene C van der Schaaf H Bart van der Worp Gert Jan R Luijckx Allart M Venema Marko M Sahinovic Rudi A J O Dierckx Hester F Lingsma Teus H Kappen Reinoud P H Bokkers MR CLEAN Registry Investigators |
| author_sort |
Sabine L Collette |
| title |
Hypotension during endovascular treatment under general anesthesia for acute ischemic stroke. |
| title_short |
Hypotension during endovascular treatment under general anesthesia for acute ischemic stroke. |
| title_full |
Hypotension during endovascular treatment under general anesthesia for acute ischemic stroke. |
| title_fullStr |
Hypotension during endovascular treatment under general anesthesia for acute ischemic stroke. |
| title_full_unstemmed |
Hypotension during endovascular treatment under general anesthesia for acute ischemic stroke. |
| title_sort |
hypotension during endovascular treatment under general anesthesia for acute ischemic stroke. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2021 |
| url |
https://doaj.org/article/ed7f2e4496a548f9ab41b2bfadeb2f21 |
| work_keys_str_mv |
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