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Research ArticleINTERVENTIONAL

The Impact of Conscious Sedation versus General Anesthesia for Stroke Thrombectomy on the Predictive Value of Collateral Status: A Post Hoc Analysis of the SIESTA Trial

S. Schönenberger, J. Pfaff, L. Uhlmann, C. Klose, S. Nagel, P.A. Ringleb, W. Hacke, M. Kieser, M. Bendszus, M.A. Möhlenbruch and J. Bösel
American Journal of Neuroradiology August 2017, 38 (8) 1580-1585; DOI: https://doi.org/10.3174/ajnr.A5243
S. Schönenberger
aFrom the Departments of Neurology (S.S., S.N., P.A.R., W.H., J.B.)
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J. Pfaff
bNeuroradiology (J.P., M.B., M.A.M.), Heidelberg University Hospital, Heidelberg, Germany
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L. Uhlmann
cInstitute of Medical Biometry and Informatics (L.U., C.K., M.K.), University of Heidelberg, Heidelberg, Germany.
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C. Klose
cInstitute of Medical Biometry and Informatics (L.U., C.K., M.K.), University of Heidelberg, Heidelberg, Germany.
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S. Nagel
aFrom the Departments of Neurology (S.S., S.N., P.A.R., W.H., J.B.)
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P.A. Ringleb
aFrom the Departments of Neurology (S.S., S.N., P.A.R., W.H., J.B.)
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W. Hacke
aFrom the Departments of Neurology (S.S., S.N., P.A.R., W.H., J.B.)
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M. Kieser
cInstitute of Medical Biometry and Informatics (L.U., C.K., M.K.), University of Heidelberg, Heidelberg, Germany.
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M. Bendszus
bNeuroradiology (J.P., M.B., M.A.M.), Heidelberg University Hospital, Heidelberg, Germany
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M.A. Möhlenbruch
bNeuroradiology (J.P., M.B., M.A.M.), Heidelberg University Hospital, Heidelberg, Germany
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J. Bösel
aFrom the Departments of Neurology (S.S., S.N., P.A.R., W.H., J.B.)
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Tables

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    Table 1:

    Baseline demographic and clinical characteristics according to no or poor (Tan 0–1) and moderate or good collaterals (Tan 2–3)

    Tan 0–1 (n = 48)Tan 2–3 (n = 56)P Value
    Demographic characteristics
        Age (mean) (SD) (yr)72.0 (11.7)73.7 (4.3).52a
    Female sex (No.) (%)17 (35.4)23 (41.1).56b
    Premedication (No.) (%)
        Antiplatelets.5b
            No33 (71.7)38 (69.1)
            Aspirin12 (26.1)13 (23.6)
            Dual1 (2.2)4 (7.3)
            Missing21
        Oral anticoagulants
            No42 (89.4)36 (65.5).01b
            Missing11
        Statins
            No37 (80.4)30 (56.6).01b
            Missing23
    Vascular risk factors (No.) (%)
        Hypertension37 (77.1)37 (66.1).22b
        Diabetes mellitus13 (27.1)10 (17.9).26b
        Hyperlipidemia12 (25.0)17 (30.4).54b
        Smokingc11 (23.4)4 (7.1).02b
        Heart failure10 (20.8)19 (27.9).14b
        Atrial fibrillation24 (50)30 (53.6).72b
        Peripheral artery occlusive diseased1 (2.1)4 (7.4).22b
    Pretreatment imaging (No.) (%)
        ASPECTS<.001b
            10–824 (50)47 (83.9)
            7–622 (45.8)7 (12.5)
            <62 (4.2)2 (3.6)
            Median (IQR)7 (6–9)9 (8–10)
        Infarct volume (mean) (SD) (cm3)107.4 (99.1)35.0 (55.1)<.001a
    Scores on admission (No.) (%)
        Premorbid mRS.02e
            030 (62.5)24 (42.9)
            111 (22.9)10 (17.9)
            24 (8.3)14 (25)
            >23 (6.3)8 (14.3)
        NIHSS on admission17.9 (3.6)16.9 (3.7).14a
        GCS on admission.8e
            126 (12.5)2 (3.6)
            1321 (43.8)31 (55.4)
            15–1421 (43.8)23 (41.2)
    Occlusion (No.) (%)
            MCA26 (54.2)39 (69.6).08b
            ICA3 (6.3)0 (0)
            ICA + MCA19 (39.6)17 (30.4)
        Occlusion side right22 (45.8)23 (44.1).63b
    Treatment of stroke.24b
        IV tPA + EST32 (66.7)31 (55.4)
        EST16 (33.3)25 (44.6)
    • Note:—GCS indicates Glasgow Coma Scale; IQR, interquartile range.

    • ↵a t test, 2-sided.

    • ↵b χ2 test, 3-sided.

    • ↵c Lower sample size in Tan group 0–1 (n = 47).

    • ↵d Lower sample size in Tan group 0–1 (n = 47) and Tan group 2–3 (n = 54).

    • ↵e Mann-Whitney U test, 2-sided.

    • View popup
    Table 2:

    SIESTA primary and secondary outcome results according to no or poor (Tan 0–1) and moderate or good collaterals (Tan 2–3)

    Tan 0–1 (n = 48)Tan 2–3 (n = 56)P Value
    Primary outcome
        Improvement in NIHSS (mean) (SD)−1.1 (10.7)−5.8 (7.6).01a
    Secondary outcomes
        Clinical (No.) (%)
            mRS 0–2 after 3 mo10 (20.8)14 (25.0).82b
            In-house mortality7 (14.6)1 (1.8).02b
            Mortality after 3 mo12 (25.0)15 (26.8).84b
    Logistics (mean) (SD)
        Length of stay in hospital (days)6.0 (3.7)4.6 (2.6).06c
        Length of stay in ICU (half-days)e8.2 (9.2)2.7 (2.2)<.001c
        Length of ventilation (hr)30.1 (5.9)3.8 (5.4).11c
        Length of stay on stroke unit (half-days)f7.6 (4.3)7.0 (4.3).5c
        Onset-to-treatment (IV or IA) (min)g122.8 (64.8)129.6 (60.9).61b
        Door-to-groin (min)71.5 (32.1)66.1 (21.4).52c
        Door-to-reperfusion (min)h174.8 (57.1)165.6 (60.5).32c
    Feasibility of EST (No.) (%)
        Degree of reperfusion (TICI).97d
            0–13 (6.3)5 (9)
            2a4 (8.3)3 (5.4)
            2b24 (50.0)25 (44.6)
            317 (35.4)23 (41.1)
        Substantial patient movement1 (2.1)2 (3.6).65b
        Difficult vascular approach3 (6.3)7 (12.5).28b
            Other3 (6.3)8 (14.3).18b
    Safety (No.) (%)
        Complications before EST
            Impaired monitor installation0 (0.0)1 (1.8).35b
            Other1 (2.1)0 (0.0).27b
        Complications during EST
            Critical ventilation or oxygenation disturbance2 (4.2)1 (1.8).47b
            Intervention-associated complications0 (0.0)2 (3.6).19b
        Vessel perforation with ICH and/or SAH complications after EST0 (0.0)2 (3.6).19b
        Hyper- or hypothermia12 (25.0)12 (21.4).67b
        Delayed extubation17 (35.4)12 (21.4).11b
        Ventilation-associated complications6 (12.5)3 (5.4).2b
        Ventilation-associated pneumonia6 (12.5)3 (5.4).2b
    • Note:—IA indicates intra-arterial; min, minimum; max, maximum; ICH, intracerebral hemorrhage; ICU, intensive care unit.

    • ↵a ANCOVA, NIHSS as baseline covariate.

    • ↵b χ2 test, 2-sided.

    • ↵c t test, 2-sided.

    • ↵d Mann-Whitney U test, 2-sided.

    • ↵e Lower sample size (41 and 46).

    • ↵f Lower sample size (31 and 51).

    • ↵g Lower sample size (41 and 47).

    • ↵h Lower sample size (45 and 49).

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American Journal of Neuroradiology: 38 (8)
American Journal of Neuroradiology
Vol. 38, Issue 8
1 Aug 2017
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S. Schönenberger, J. Pfaff, L. Uhlmann, C. Klose, S. Nagel, P.A. Ringleb, W. Hacke, M. Kieser, M. Bendszus, M.A. Möhlenbruch, J. Bösel
The Impact of Conscious Sedation versus General Anesthesia for Stroke Thrombectomy on the Predictive Value of Collateral Status: A Post Hoc Analysis of the SIESTA Trial
American Journal of Neuroradiology Aug 2017, 38 (8) 1580-1585; DOI: 10.3174/ajnr.A5243

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The Impact of Conscious Sedation versus General Anesthesia for Stroke Thrombectomy on the Predictive Value of Collateral Status: A Post Hoc Analysis of the SIESTA Trial
S. Schönenberger, J. Pfaff, L. Uhlmann, C. Klose, S. Nagel, P.A. Ringleb, W. Hacke, M. Kieser, M. Bendszus, M.A. Möhlenbruch, J. Bösel
American Journal of Neuroradiology Aug 2017, 38 (8) 1580-1585; DOI: 10.3174/ajnr.A5243
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