02.10.19

Patients with acute ischemic stroke have better outcomes if thrombectomy is performed in general instead of local anaesthesia. This is the result of new research from Aarhus University Hospital and Aarhus University in Denmark.

The type of anaesthesia is rarely important to patient outcome after surgery or a procedure. However, this is the case in a new study from Aarhus University Hospital and Aarhus University, which has just been published in the acknowledged scientific journal JAMA.

The results show that patients undergoing thrombectomy in connection with acute ischemic stroke have a better outcome if the procedure is performed in general instead of local anaesthesia.

General anaesthesia is best
During mechanical thrombectomy, a blood clot is removed from the brain. A thin catheter is inserted into one of the large arteries at the groin until it reaches the blood clot which is then removed.

This is a highly specialised treatment only performed at four hospitals in Denmark. It can be highly effective in patients with a large acute ischemic stroke, and some patients recover with almost no disabilities.

Previously, the general perception was that local anaesthesia was best because you could avoid a fall in the blood pressure during the procedure. A new research project from Aarhus University Hospital and Aarhus University in collaboration with the university hospitals in Heidelberg and Sahlgrenska show that general anaesthesia is best.

The degree of disability is lower
A total of 368 patients participated in the studies. The participants were randomly assigned to receive either general or local anaesthesia; after three months, the patients’ functional level was measured.

- We found that the degree of disability was lower after thrombectomy performed in general compared with local anaesthesia. This means that the patients undergoing general anaesthesia have a better life after the acute ischemic stroke, says Mads Rasmussen, consultant at Department of Anaesthesiology and Intensive Care at Aarhus University Hospital and clinical associate professor at Department of Clinical Medicine, Aarhus University.

- The reason is that a patient in general anaesthesia lies completely still and this is very important when inserting a catheter into the brain. At the same time, we can see that the blood flow in the damaged part of the brain is better restored in patients in general anaesthesia.

More thrombectomy procedures in general anaesthesia
Last year, Aarhus University Hospital performed 250 thrombectomies. The number is increasing and this year it is expected to reach 300.

- The new research will result in more patients undergoing thrombectomy in general anaesthesia at Aarhus University Hospital. Moreover, the research results will change treatment of patients with acute ischemic stroke internationally, says Claus Z. Simonsen, consultant at Department of Neurology, Aarhus University Hospital and clinical associate professor at Department of Clinical Medicine, Aarhus University.

The research results are based on a so-called meta-analysis where data from three studies performed at the university hospitals in Aarhus, Heidelberg in Germany and Sahlgrenska in Sweden have been pooled. The Danish study – GOLIATH – has recently been awarded the best European publication in 2019 in the Journal of NeuroInterventional Surgery (JNIS).

Behind the research result:
Study type: Meta-analysis of individual patient data from three randomised studies.

Collaborators: Researchers form neurology, brain and back surgery and Department of Anaesthesiology and Intensive Care, Aarhus University Hospital. Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany. Department of Neurology, Klinikum Kassel, Kassel, Germany. Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.

External financing: Claus Z. Simonsen has received funding from the Novo Nordisk Fonden. Mads Rasmussen has received funding from the research fund in Central Denmark Region.

Publication: Peer-reviewed article in JAMA, published by the American Medical Association.

Conflicts of interest: None.

Reference to original article:

Schönenberger S, Löwhagen Hendén P, Simonsen CZ, Uhlmann L,Klose C, Pfaff JAR, Yoo AJ, Sørensen LH, Ringleb PA, Wick W, Kieser M, Möhlenbruch MA, Rasmussen M, Rentzos A, Bösel J.

Association of general anesthesia vs. procedural sedation with functional outcome among patients with acute ischemic stroke undergoing thrombectomy: A systematic review and meta-analysis [published online October 1, 2019]. JAMA.

https://jamanetwork.com/journals/jama/fullarticle/2752061

Further information:

Mads Rasmussen, consultant, Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Denmark and clinical associate professor, Department of Clinical Medicine, Aarhus University, Denmark.
Tel.: +45 30 56 69 77, e-mail: madrasmu@rm.dk  

Claus Z. Simonsen, consultant, Department of Neurology, Aarhus University Hospital, Denmark and Department of Clinical Medicine, Aarhus University, Denmark.
Tel.: +45 50 24 05 43, e-mail: clausimo@rm.dk