Effect Of Anesthesia On The Prognosis Of Endovascular Treatment Of Acute Anterior Circulation Large Vessel Occlusive Cerebral Infarction

Background:Cerebral infarction is a chronic non-infectious disease that endangers people’s health and is an important cause of death and disability,especially cerebral infarction with large vessel occlusion.With the continuous development of economy and society and the improvement of lifestyle,the incidence of cerebral infarction is increasing day by day,which brings a heavy burden to individuals,families and society.Five major clinical studies（MR CLEAN,ESCAPE,EXTEND IA,SWIFT PRIME,REVASCAT）published in New England Journal of Medicine in 2015 proved that mechanical thrombectomy within the time window（≤6h）is safe and effective for acute ischemic stroke,which lays a solid foundation for endovascular therapy.The DAWN and DEFUSE-3 studies published later gave some patients with 6-24 hours of onset the opportunity to receive endovascular treatment.However,the prognosis of endovascular therapy is affected by many factors,such as ASPECT score,core infarct volume,collateral circulation,thrombus burden,and anesthesia method.Among them,anesthesia is one of the important factors affecting the prognosis of endovascular treatment.Studies have shown that endovascular therapy to open blood vessels as soon as possible under conscious sedation has a better clinical prognosis than general anesthesia.Some studies have also shown that there is no exact relationship between anesthesia mode and clinical prognosis.The effect of anesthesia on the prognosis and safety of endovascular treatment in patients with cerebral infarction needs further high-quality clinical research to explore.Objective:To retrospectively analyze the cases of acute ischemic stroke who received endovascular treatment in the Senior Stroke Center of Jilin University China-Japan Union Hospital,and to explore the effect of different anesthesia methods on disease outcome and prognosis in patients with acute ischemic stroke who received endovascular treatment.Methods:Patients with acute ischemic stroke who were treated at the Advanced Stroke Center of China-Japan Union Hospital of Jilin University and started endovascular treatment during 2018.09-2021.09 were collected,and eligible patients were screened for the presence of acute occlusion of the internal carotid artery and confirmed by digital subtraction cerebral arteriography.Patients receiving endovascular therapy were classified by general anesthesia and conscious sedation,and the prognosis of the two groups was analyzed.Main observation indicator: Telephone follow-up or outpatient face-to-face consultation after 90 days,and modified Rankin scale was used to evaluate the recovery of long-term living ability.Secondary observation indicators included postoperative m TICI to evaluate vascular recanalization,and 24-hour postoperative NIHSS score.Safety observation indicators mainly include pneumonia,symptomatic intracranial hemorrhage,and death.Results:（1）.A total of 137 patients were included,including 95 in the general anesthesia group and 42 in the conscious sedation group.There was no statistical difference in the clinical baseline characteristics of the two groups;（2）.There was no significant difference in the 24-hour NIHSS score and its improvement,m TICI,and 90-day m RS between general anesthesia group and conscious sedation group;（3）.There was no significant difference in safety events such as pneumonia,symptomatic intracranial hemorrhage,and death between the general anesthesia group and conscious sedation group.（4）.The time from onset to hospital admission is an independent predictor of the prognosis of endovascular treatment in patients with large-vessel-occlusion acute ischemic stroke.Conclusion:（1）.For patients with acute ischemic stroke with anterior circulation large vessel occlusion receiving endovascular therapy,the choice of conscious sedation and general anesthesia has no significant effect on the good clinical prognosis at 90 days.The decision is individualized according to the patients’ preoperative and intraoperative conditions.（2）.General anesthesia and conscious sedation were not significantly associated with postoperative complications,death and other adverse events in patients with acute ischemic stroke undergoing endovascular treatment.（3）.The time from onset to hospital admission is an important factor affecting the clinical prognosis of patients with acute ischemic stroke receiving endovascular therapy.