Endovascular treatment of acute ischaemic stroke under conscious sedation: Predictors of poor outcomes

• Main Authors: Umeshkumar Athiraman, Arbi Ben Abdallah, Akash Kansagra, Rene Tempelhoff
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2018-01-01
• Series: Indian Journal of Anaesthesia
• Subjects: Acute ischaemic stroke; conscious sedation; endovascular treatment; outcomes
• Online Access: http://www.ijaweb.org/article.asp?issn=0019-5049;year=2018;volume=62;issue=12;spage=951;epage=957;aulast=Athiraman

Background and Aims: Though, many practitioners prefer conscious sedation (CS), it is unclear which factors most influence neurological outcome following mechanical thrombectomy under CS. The aim of this retrospective study is to identify these factors. Methods: After institutional review board approval, data were collected for the patients >18 years of age who underwent endovascular treatment of AIS under CS at our comprehensive stroke centre between January 2009 and June 2015. The primary outcome measure was the modified Rankin Scale (mRS) at discharge. A good outcome was defined as mRS 0–3 and poor outcome as mRS 4–6. Univariate and logistic regression analysis were performed to identify the independent predictors of poor outcomes at discharge. A P < 0.05 was considered statistically significant. Results: One hundred two patients, aged 67 ± 16 years were included. The anterior cerebral circulation was affected in 88 patients (86%), and the median National Institute of Health Stroke Scale (NIHSS) score at presentation was 17.5 (range: 1–36). Overall, 21 (21%) patients had good outcome and 81 (79%) had poor outcome. Logistic regression identified the modified treatment in cerebral ischaemia (mTICI) score [odds ratio (OR): 0.443, confidence interval (CI): 0.244–0.805], NIHSS score (OR: 1.290, CI: 1.125–1.481) and previous transient ischaemic attack (TIA) (OR: 6.988, CI: 1.342–36.380) as significant independent predictors of poor outcome at discharge. Conclusion: The outcome of patients who underwent endovascular treatment of AIS under CS depends on the mTICI score, NIHSS score and history of previous TIA.