Conscious Sedation Increases Risk of Poor Functional Outcome, Mortality Following Stroke Treatment

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Conscious sedation is commonly used during intra-arterial treatment for large-vessel occlusions in acute ischemic stroke.
Conscious sedation is commonly used during intra-arterial treatment for large-vessel occlusions in acute ischemic stroke.

Conscious sedation is associated with a higher risk for poor functional outcomes and mortality compared with local anesthesia for intra-arterial treatment (IAT) for acute ischemic stroke, according to a study reported in Neurology.

A team of researchers in The Netherlands analyzed outcomes of patients with acute ischemic stroke who were enrolled in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry. Patients underwent IAT at a single center that offered conscious sedation as standard care during a specific time window, which allowed the researchers to reduce selection bias.

The investigators compared patients (N=146) with acute ischemic stroke who received either conscious sedation (n=60) or local anesthesia (n=86) at a groin puncture site during IAT. 

The primary outcome was 90-day score on the 7-point modified Rankin Scale (mRS), which ranged from 0 (no symptoms) to 6 (dead). Additionally, the researchers compared conscious sedation with local anesthesia in regard to the association between treatment and a “good” functional outcome (defined as an mRS score ≤2) as well as 7-, 30-, and 90-day mortality rates.

Compared with local anesthesia, there was a trend toward worse mRS scores at 90 days in patients undergoing conscious sedation during IAT (odds ratio [OR] 0.4; 95% CI, 0.2-0.7). Additionally, the investigators observed higher 90-day mortality rates among the cohort receiving conscious sedation vs local anesthesia (OR 2.3; 95% CI, 1.0-5.2). No difference was seen between the 2 groups with regard to procedure-related complications (OR 1.3; 95% CI, 0.6-2.7]). In addition, the researchers found no statistically significant differences between conscious sedation and local anesthesia in terms of the mean procedure duration (77 minutes vs 69 minutes, OR 6.3; 95% CI, -7.4 to 20.0).

The nonrandomized, single-center design represents a limitation of this study, which may limit generalizability across other sites.

Although local anesthesia may confer less risk for mortality and poor functional outcomes following IAT, the investigators comment that in light of “patient movement and need for procedural comfort, the use of CS is sometimes inevitable.”

Reference

van de Graaf RA, Samuels N, Mulder MJHL, et al; for the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry Investigators. Conscious sedation or local anesthesia during endovascular treatment for acute ischemic stroke. Neurology. 2018;91(1):e19-e25.

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