Anesthesia, Blood Pressure, and Socioeconomic Status in Endovascular Thrombectomy for Acute Stroke: A Single Center Retrospective Case Cohort. Issue 1 (12th January 2023)

• Record Type: Journal Article
• Authors: Hoefnagel, Amie L.; Yao, Joyce; Rao, Dinesh; Kovacs, Peter; Brzezicki, Grzegorz; Mongan, Paul D.
• Is Part Of: Journal of neurosurgical anesthesiology. Volume 35:Issue 1(2023)
• Page Start: 41
• Page End: 48
• Publication Date: 2023-01-12
• Subjects: acute ischemic stroke -- anesthesia -- general -- conscious sedation -- health care disparities -- mechanical thrombolysis -- socioeconomic factors -- area of deprivation index; Anesthesia in neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; 617.96748
• DOI: 10.1097/ANA.0000000000000790
• Languages: English
• ISSNs: 0898-4921

Abstract

Abstract : Introduction: Mechanical thrombectomy (MT) is standard for acute ischemic stroke (AIS), with early studies suggesting that general anesthesia (GA) is associated with worse outcomes than monitored anesthesia care (MAC). Socioeconomic deprivation is also a risk factor for worse AIS outcomes. With improvements in MT and blood pressure (BP) management, it remains unclear if GA or socioeconomic deprivation are risk factors for worse outcomes after MT. Methods: We retrospectively analyzed 125 consecutive AIS patients presenting for MT at a comprehensive stroke center serving patients with high levels of socioeconomic deprivation. The primary objective was impact of GA versus MAC on functional independence at 90 days. Secondary outcomes included procedural BP, and impact of BP and socioeconomic deprivation (assessed by the area of deprivation index) on outcomes. Results: A 90-day outcomes were similar in patients undergoing MT with GA or MAC. The area of deprivation index was similar in GA and MAC groups and in patients with good versus poor 90-day outcomes. There were similar numbers of patients with mean arterial pressure (MAP) <60 mm Hg in the MAC and GA groups (8 vs. 11; P =0.21), but more patients with MAP <70 mm Hg in the GA group (28 vs. 9; P <0.001). Median (interquartile range) duration of MAP <70 mm Hg was 10 (5 to 15) and 20 (10 to 36) minutes in the MAC and GA groups, respectively ( P <0.001); however, these MAPs were not associated with worse 90-day outcomes. Conclusion: Anesthesia and MAP did not affect MT outcomes. The cohort is unique based on an area of deprivation index in the higher deciles in the United States. While the area of deprivation index was not associated with worse outcomes, further study is warranted.