The effect of anesthetic management during intra-arterial therapy for acute stroke in MR CLEAN
© 2016 American Academy of Neurology..
BACKGROUND: The aim of the current study was to assess the influence of anesthetic management on the effect of treatment in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN).
METHODS: MR CLEAN was a multicenter, randomized, open-label trial of intra-arterial therapy (IAT) vs no IAT. The intended anesthetic management at the start of the procedure was used for this post hoc analysis. The primary effect parameter was the adjusted common odds ratio (acOR) for a shift in direction of a better outcome on the modified Rankin Scale (mRS) at 90 days, estimated with multivariable ordinal logistic regression analysis, which included a term for general anesthesia (GA).
RESULTS: GA was associated with significant (p = 0.011) effect modification, resulting in estimated decrease of 51% (95% confidence interval [CI] 31%-86%) in treatment effect compared to non-GA. We found a shift in the distribution on the mRS in favor of non-GA compared to control group (acOR 2.18 [95% CI 1.49-3.20]). The shift in distribution between GA and control group was in a similar direction (acOR 1.12 [95% CI 0.71-1.78]) with loss of statistical significance.
CONCLUSIONS: In this post hoc analysis, we found that the type of anesthetic management influences outcome following IAT. Only treatment without general anesthesia was associated with a significant treatment benefit in MR CLEAN.
CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for patients with acute ischemic stroke undergoing IAT, mRS scores at 90 days improve only in patients treated without GA.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2016 |
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| Erschienen: |
2016 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:87 |
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| Enthalten in: |
Neurology - 87(2016), 7 vom: 16. Aug., Seite 656-64 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Berkhemer, Olvert A [VerfasserIn] |
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| Anmerkungen: |
Date Completed 29.05.2017 Date Revised 31.03.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1212/WNL.0000000000002976 |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM262470233 |
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| 041 | |a eng | ||
| 100 | 1 | |a Berkhemer, Olvert A |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The effect of anesthetic management during intra-arterial therapy for acute stroke in MR CLEAN |
| 264 | 1 | |c 2016 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 29.05.2017 | ||
| 500 | |a Date Revised 31.03.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2016 American Academy of Neurology. | ||
| 520 | |a BACKGROUND: The aim of the current study was to assess the influence of anesthetic management on the effect of treatment in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) | ||
| 520 | |a METHODS: MR CLEAN was a multicenter, randomized, open-label trial of intra-arterial therapy (IAT) vs no IAT. The intended anesthetic management at the start of the procedure was used for this post hoc analysis. The primary effect parameter was the adjusted common odds ratio (acOR) for a shift in direction of a better outcome on the modified Rankin Scale (mRS) at 90 days, estimated with multivariable ordinal logistic regression analysis, which included a term for general anesthesia (GA) | ||
| 520 | |a RESULTS: GA was associated with significant (p = 0.011) effect modification, resulting in estimated decrease of 51% (95% confidence interval [CI] 31%-86%) in treatment effect compared to non-GA. We found a shift in the distribution on the mRS in favor of non-GA compared to control group (acOR 2.18 [95% CI 1.49-3.20]). The shift in distribution between GA and control group was in a similar direction (acOR 1.12 [95% CI 0.71-1.78]) with loss of statistical significance | ||
| 520 | |a CONCLUSIONS: In this post hoc analysis, we found that the type of anesthetic management influences outcome following IAT. Only treatment without general anesthesia was associated with a significant treatment benefit in MR CLEAN | ||
| 520 | |a CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for patients with acute ischemic stroke undergoing IAT, mRS scores at 90 days improve only in patients treated without GA | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 700 | 1 | |a van den Berg, Lucie A |e verfasserin |4 aut | |
| 700 | 1 | |a Fransen, Puck S S |e verfasserin |4 aut | |
| 700 | 1 | |a Beumer, Debbie |e verfasserin |4 aut | |
| 700 | 1 | |a Yoo, Albert J |e verfasserin |4 aut | |
| 700 | 1 | |a Lingsma, Hester F |e verfasserin |4 aut | |
| 700 | 1 | |a Schonewille, Wouter J |e verfasserin |4 aut | |
| 700 | 1 | |a van den Berg, René |e verfasserin |4 aut | |
| 700 | 1 | |a Wermer, Marieke J H |e verfasserin |4 aut | |
| 700 | 1 | |a Boiten, Jelis |e verfasserin |4 aut | |
| 700 | 1 | |a Lycklama À Nijeholt, Geert J |e verfasserin |4 aut | |
| 700 | 1 | |a Nederkoorn, Paul J |e verfasserin |4 aut | |
| 700 | 1 | |a Hollmann, Markus W |e verfasserin |4 aut | |
| 700 | 1 | |a van Zwam, Wim H |e verfasserin |4 aut | |
| 700 | 1 | |a van der Lugt, Aad |e verfasserin |4 aut | |
| 700 | 1 | |a van Oostenbrugge, Robert J |e verfasserin |4 aut | |
| 700 | 1 | |a Majoie, Charles B L M |e verfasserin |4 aut | |
| 700 | 1 | |a Dippel, Diederik W J |e verfasserin |4 aut | |
| 700 | 1 | |a Roos, Yvo B W E M |e verfasserin |4 aut | |
| 700 | 0 | |a MR CLEAN investigators |e verfasserin |4 aut | |
| 700 | 1 | |a Dippel, Diederik |e investigator |4 oth | |
| 700 | 1 | |a Roos, Yvo |e investigator |4 oth | |
| 700 | 1 | |a van Oostenbrugge, Robert |e investigator |4 oth | |
| 700 | 1 | |a Boiten, Jelis |e investigator |4 oth | |
| 700 | 1 | |a Wermer, Marieke |e investigator |4 oth | |
| 700 | 1 | |a Kappelle, Jaap |e investigator |4 oth | |
| 700 | 1 | |a van Dijk, Ewoud |e investigator |4 oth | |
| 700 | 1 | |a Schonewille, Wouter |e investigator |4 oth | |
| 700 | 1 | |a Hofmeijer, Jeannette |e investigator |4 oth | |
| 700 | 1 | |a Vroomen, Patrick |e investigator |4 oth | |
| 700 | 1 | |a de Kort, Paul |e investigator |4 oth | |
| 700 | 1 | |a Keizer, Koos |e investigator |4 oth | |
| 700 | 1 | |a de Bruijn, Sebastiaan |e investigator |4 oth | |
| 700 | 1 | |a van den Berg, Peter |e investigator |4 oth | |
| 700 | 1 | |a Schreuder, Tobien |e investigator |4 oth | |
| 700 | 1 | |a Aerden, Leo |e investigator |4 oth | |
| 700 | 1 | |a Visser, Marieke |e investigator |4 oth | |
| 700 | 1 | |a den Hertog, Heleen |e investigator |4 oth | |
| 700 | 1 | |a Brouwer, Patrick |e investigator |4 oth | |
| 700 | 1 | |a Majoie, Charles |e investigator |4 oth | |
| 700 | 1 | |a van Zwam, Wim |e investigator |4 oth | |
| 700 | 1 | |a Lycklama À Nijeholt, Geert |e investigator |4 oth | |
| 700 | 1 | |a van Walderveen, Marianne |e investigator |4 oth | |
| 700 | 1 | |a Lo, Rob |e investigator |4 oth | |
| 700 | 1 | |a de Vries, Joost |e investigator |4 oth | |
| 700 | 1 | |a Vos, Jan Albert |e investigator |4 oth | |
| 700 | 1 | |a van Oostayen, Jacques |e investigator |4 oth | |
| 700 | 1 | |a Eshgi, Omid |e investigator |4 oth | |
| 700 | 1 | |a Tielbeek, Xander |e investigator |4 oth | |
| 700 | 1 | |a van Dijk, Lukas |e investigator |4 oth | |
| 700 | 1 | |a van Hasselt, Boudewijn |e investigator |4 oth | |
| 700 | 1 | |a Heijboer, Roel |e investigator |4 oth | |
| 700 | 1 | |a Dallinga, René |e investigator |4 oth | |
| 700 | 1 | |a Bot, Joost |e investigator |4 oth | |
| 700 | 1 | |a Gerrits, Dick |e investigator |4 oth | |
| 700 | 1 | |a Berkhemer, Olvert |e investigator |4 oth | |
| 700 | 1 | |a van den Berg, Lucie |e investigator |4 oth | |
| 700 | 1 | |a Beumer, Debbie |e investigator |4 oth | |
| 700 | 1 | |a Fransen, Puck |e investigator |4 oth | |
| 700 | 1 | |a van der Lugt, Aad |e investigator |4 oth | |
| 700 | 1 | |a Marquering, Henk |e investigator |4 oth | |
| 700 | 1 | |a Beenen, Ludo |e investigator |4 oth | |
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| 700 | 1 | |a Koudstaal, Peter |e investigator |4 oth | |
| 700 | 1 | |a Steyerberg, Ewout |e investigator |4 oth | |
| 700 | 1 | |a Andersson, Tommy |e investigator |4 oth | |
| 700 | 1 | |a Mattle, Heinrich |e investigator |4 oth | |
| 700 | 1 | |a Wahlgren, Nils |e investigator |4 oth | |
| 700 | 1 | |a Jenniskens, Sjoerd |e investigator |4 oth | |
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| 700 | 1 | |a Karas, Giorgos |e investigator |4 oth | |
| 700 | 1 | |a Nederkoorn, Paul |e investigator |4 oth | |
| 700 | 1 | |a Staals, Julie |e investigator |4 oth | |
| 700 | 1 | |a Emmer, Bart |e investigator |4 oth | |
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