Effect of General Anesthesia vs. Conscious Sedation on the Outcomes of Acute Ischemic Stroke Patients After Endovascular Therapy: A Meta-Analysis of Randomized Clinical Trials
Background: Endovascular therapy is the standard treatment for acute ischemic stroke (AIS) patients caused by a large vessel occlusion in the anterior circulation, whereas the impacts of general anesthesia (GA) vs. conscious sedation (CS) for such procedures remained as a continued debate.Methods: W...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-10-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2019.01131/full |
| _version_ | 1811270178644688896 |
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| author | Teng-Fei Wan Jian-Rong Zhang Liang Liu |
| author_facet | Teng-Fei Wan Jian-Rong Zhang Liang Liu |
| author_sort | Teng-Fei Wan |
| collection | DOAJ |
| description | Background: Endovascular therapy is the standard treatment for acute ischemic stroke (AIS) patients caused by a large vessel occlusion in the anterior circulation, whereas the impacts of general anesthesia (GA) vs. conscious sedation (CS) for such procedures remained as a continued debate.Methods: We systematically searched PubMed, Embase, and ClinicalTrials.gov. We restricted our search to RCTs that examined the clinical outcomes of endovascular therapy with GA vs. CS. The Cochrane Risk of Bias Tool was used to assess study quality. Random-effects or fixed-effects meta-analyses were used for evaluating all outcomes.Results: A total of three randomized clinical trials met our inclusion criteria, with 368 individuals enrolled. Patients were randomized to receive GA or CS during endovascular therapy. In a meta-analysis of these trials, patients in the GA group were associated with favorable functional outcome (mRS score ≤ 2) compared with the CS group (pooled OR = 1.81, 95% CI: 1.17–2.79, P = 0.008). Besides, patients in the GA group had higher odds of successful reperfusion (pooled OR = 1.80, 95% CI: 1.05–3.08, P = 0.033), but no significant differences were seen in symptomatic intracranial hemorrhage (pooled OR = 0.54, 95% CI: 0.11–2.57, P = 0.308), vessel dissection or perforation (pooled OR = 1.38, 95% CI: 0.30–6.31, P = 0.679), migration of embolus to a new territory (pooled OR = 2.28, 95% CI: 0.89–5.87, P = 0.085), post-operative pneumonia (pooled OR = 1.74, 95% CI: 0.76–4.01, P = 0.149), and all-cause mortality at 90 days (pooled OR = 0.73, 95% CI: 0.43–1.26, P = 0.263) compared with the CS group.Conclusion: Performing endovascular therapy with GA, compared with CS, improves functional independence after 90 days significantly for patients with AIS caused by a large vessel occlusion in the anterior circulation. However, additional larger and multi-center randomized controlled trials to definitively confirm our findings are warranted for the limitation of the small sample size in this study. |
| first_indexed | 2024-04-12T21:56:11Z |
| format | Article |
| id | doaj.art-60f7547513224101b33b62d5ad6d575f |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-12T21:56:11Z |
| publishDate | 2019-10-01 |
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| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-60f7547513224101b33b62d5ad6d575f2022-12-22T03:15:19ZengFrontiers Media S.A.Frontiers in Neurology1664-22952019-10-011010.3389/fneur.2019.01131477783Effect of General Anesthesia vs. Conscious Sedation on the Outcomes of Acute Ischemic Stroke Patients After Endovascular Therapy: A Meta-Analysis of Randomized Clinical TrialsTeng-Fei Wan0Jian-Rong Zhang1Liang Liu2Department of First Cadre Ward, The General Hospital of Northern Theater Command, Shenyang, ChinaDepartment of Neurology, Xinqiao Hospital, The Army Military Medical University, Chongqing, ChinaDepartment of Neurology, The General Hospital of Northern Theater Command, Shenyang, ChinaBackground: Endovascular therapy is the standard treatment for acute ischemic stroke (AIS) patients caused by a large vessel occlusion in the anterior circulation, whereas the impacts of general anesthesia (GA) vs. conscious sedation (CS) for such procedures remained as a continued debate.Methods: We systematically searched PubMed, Embase, and ClinicalTrials.gov. We restricted our search to RCTs that examined the clinical outcomes of endovascular therapy with GA vs. CS. The Cochrane Risk of Bias Tool was used to assess study quality. Random-effects or fixed-effects meta-analyses were used for evaluating all outcomes.Results: A total of three randomized clinical trials met our inclusion criteria, with 368 individuals enrolled. Patients were randomized to receive GA or CS during endovascular therapy. In a meta-analysis of these trials, patients in the GA group were associated with favorable functional outcome (mRS score ≤ 2) compared with the CS group (pooled OR = 1.81, 95% CI: 1.17–2.79, P = 0.008). Besides, patients in the GA group had higher odds of successful reperfusion (pooled OR = 1.80, 95% CI: 1.05–3.08, P = 0.033), but no significant differences were seen in symptomatic intracranial hemorrhage (pooled OR = 0.54, 95% CI: 0.11–2.57, P = 0.308), vessel dissection or perforation (pooled OR = 1.38, 95% CI: 0.30–6.31, P = 0.679), migration of embolus to a new territory (pooled OR = 2.28, 95% CI: 0.89–5.87, P = 0.085), post-operative pneumonia (pooled OR = 1.74, 95% CI: 0.76–4.01, P = 0.149), and all-cause mortality at 90 days (pooled OR = 0.73, 95% CI: 0.43–1.26, P = 0.263) compared with the CS group.Conclusion: Performing endovascular therapy with GA, compared with CS, improves functional independence after 90 days significantly for patients with AIS caused by a large vessel occlusion in the anterior circulation. However, additional larger and multi-center randomized controlled trials to definitively confirm our findings are warranted for the limitation of the small sample size in this study.https://www.frontiersin.org/article/10.3389/fneur.2019.01131/fullacute ischemic strokegeneral anesthesiaconscious sedationendovascular treatmentmeta-analysis |
| spellingShingle | Teng-Fei Wan Jian-Rong Zhang Liang Liu Effect of General Anesthesia vs. Conscious Sedation on the Outcomes of Acute Ischemic Stroke Patients After Endovascular Therapy: A Meta-Analysis of Randomized Clinical Trials Frontiers in Neurology acute ischemic stroke general anesthesia conscious sedation endovascular treatment meta-analysis |
| title | Effect of General Anesthesia vs. Conscious Sedation on the Outcomes of Acute Ischemic Stroke Patients After Endovascular Therapy: A Meta-Analysis of Randomized Clinical Trials |
| title_full | Effect of General Anesthesia vs. Conscious Sedation on the Outcomes of Acute Ischemic Stroke Patients After Endovascular Therapy: A Meta-Analysis of Randomized Clinical Trials |
| title_fullStr | Effect of General Anesthesia vs. Conscious Sedation on the Outcomes of Acute Ischemic Stroke Patients After Endovascular Therapy: A Meta-Analysis of Randomized Clinical Trials |
| title_full_unstemmed | Effect of General Anesthesia vs. Conscious Sedation on the Outcomes of Acute Ischemic Stroke Patients After Endovascular Therapy: A Meta-Analysis of Randomized Clinical Trials |
| title_short | Effect of General Anesthesia vs. Conscious Sedation on the Outcomes of Acute Ischemic Stroke Patients After Endovascular Therapy: A Meta-Analysis of Randomized Clinical Trials |
| title_sort | effect of general anesthesia vs conscious sedation on the outcomes of acute ischemic stroke patients after endovascular therapy a meta analysis of randomized clinical trials |
| topic | acute ischemic stroke general anesthesia conscious sedation endovascular treatment meta-analysis |
| url | https://www.frontiersin.org/article/10.3389/fneur.2019.01131/full |
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