Evidence map›Paper›PMID 25395655›Full record

SynthesisAJNR. American journal of neuroradiology2015

Conscious sedation versus general anesthesia during endovascular acute ischemic stroke treatment: a systematic review and meta-analysis.

W Brinjikji, M H Murad, A A Rabinstein, H J Cloft, G Lanzino, D F Kallmes

Registry-linked trialOpen access · hybridAbstract readComparative StudyMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in AJNR. American journal of neuroradiology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03247998 (GASTROKE- the Effect of General Anesthesia Versus Sedation for Patients With Acute Ischemic STROKE Undergoing Endovascular Treatment on Three Month Morbidity and Mortality), which is not on this map. Cited by 91 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
91citing papers in PubMed, 11 pooled it
22.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03247998 naunknown statusnot on this mapstarted 2017, after this paper: background citation

GASTROKE- the Effect of General Anesthesia Versus Sedation for Patients With Acute Ischemic STROKE Undergoing Endovascular Treatment on Three Month Morbidity and Mortality: a Feasibility Study.

TypeinterventionalSponsorLondon Health Sciences Centre Research Institute OR Lawson Research Institute of St. Joseph'sRan2017 to 2019Enrolled20ConditionsStroke, Endovascular Repair, AnesthesiaArmsGeneral Anesthesia, Conscious Sedation with Remifentanil
3 · Its place in the literature

Who cites it

91 citing papers in PubMed, 11 syntheses or guidelines pooled it, 254 citations in OpenAlex.

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  17. ADVANCE: An effective and feasible technique in acute stroke treatment.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2017
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31 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 3 countries.

W BrinjikjiFrom the Departments of Radiology (W.B., H.J.C., G.L., D.F.K.) brinjikji.waleed@mayo.edu.
M H MuradCenter for the Science of Healthcare Delivery and the Division of Preventive Medicine (M.H.M.), Mayo Clinic, Rochester, Minnesota.
A A RabinsteinNeurology (A.A.R.).
H J CloftFrom the Departments of Radiology (W.B., H.J.C., G.L., D.F.K.) Neurosurgery (H.J.C., G.L., D.F.K.).
G LanzinoFrom the Departments of Radiology (W.B., H.J.C., G.L., D.F.K.) Neurosurgery (H.J.C., G.L., D.F.K.).
D F KallmesFrom the Departments of Radiology (W.B., H.J.C., G.L., D.F.K.) Neurosurgery (H.J.C., G.L., D.F.K.).
Research Institute of Radiology · BYAnna Needs Neuroblastoma Answers · USKajima Corporation (Japan) · JPMayo Clinic · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and purposeA number of studies have suggested that anesthesia type (conscious sedation versus general anesthesia) during intra-arterial treatment for acute ischemic stroke has implications for patient outcomes. We performed a systematic review and meta-analysis of studies comparing the clinical and angiographic outcomes of the 2 anesthesia types. MATERIALS AND

methodsIn March 2014, we conducted a computerized search of MEDLINE and EMBASE for reports on anesthesia and endovascular treatment of acute ischemic stroke. Using random-effects meta-analysis, we evaluated the following outcomes: recanalization rate, good functional outcome (mRS ≤ 2), asymptomatic and symptomatic intracranial hemorrhage, death, vascular complications, respiratory complications, procedure time, time to groin, and time from symptom onset to recanalization.

resultsNine studies enrolling 1956 patients (814 with general anesthesia and 1142 with conscious sedation) were included. Compared with patients treated by using conscious sedation during stroke intervention, patients undergoing general anesthesia had higher odds of death (OR = 2.59; 95% CI, 1.87-3.58) and respiratory complications (OR = 2.09; 95% CI, 1.36-3.23) and lower odds of good functional outcome (OR = 0.43; 95% CI, 0.35-0.53) and successful angiographic outcome (OR = 0.54; 95% CI, 0.37-0.80). No difference in procedure time (P = .28) was seen between the groups. Preintervention NIHSS scores were available from 6 studies; in those, patients receiving general anesthesia had a higher average NIHSS score.

conclusionsPatients with acute ischemic stroke undergoing intra-arterial therapy may have worse outcomes with general anesthesia compared with conscious sedation. However, the difference in stroke severity at the onset may confound the comparison in the available studies; thus, a randomized trial is necessary to confirm this association.

Indexed as

Anesthesia, GeneralEndovascular ProceduresProcedural SedationThrombectomyBrain IschemiaCerebral AngiographyHumansRecovery of FunctionStrokeThrombolytic TherapyTreatment Outcome

Identifiers

PMID25395655
PMCPMC8013063
OpenAlexW2084487211

What OpenQuestion holds

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Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.