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Occurrence of secondary insults during endovascular treatment of acute ischemic stroke and impact on outcome: the SIR-STROKE prospective observational study

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Abstract

Background

Neurological outcome after endovascular treatment (EVT) of acute ischemic stroke (AIS) may depend on both patient-specific and procedural factors. We hypothesized that altered systemic homeostasis might be frequent and affect outcome in these patients. The aim of this study was to analyze secondary insults during EVT of AIS and its association with outcome and anesthesiologic regimen.

Methods

This was a single-center prospective observational study on patients undergoing EVT for AIS under local anesthesia (LA), conscious sedation (CS), or general anesthesia (GA). Altered systemic parameters were recorded and quantified as secondary insults. The primary endpoint was to evaluate number, duration, and severity of secondary insults during EVT. Secondary endpoints were to analyze association of insults with modified Rankin Scale at 90 days and anesthesiologic regimen.

Results and conclusions

One hundred twenty patients were enrolled. Overall, 78% of patients experienced at least one episode of hypotension, 21% hypertension, 54% hypoxemia, 16% bradycardia, and 13% tachycardia. In patients monitored with capnometry, 70% experienced hypocapnia and 21% hypercapnia. LA was selected in 24 patients, CS in 84, and GA in 12. Hypotension insult was more frequent during GA than LA and CS (p = 0.0307), but intraprocedural blood pressure variation was higher during CS (p = 0.0357). Hypoxemia was more frequent during CS (p = 0.0087). Proportion of hypotension duration was higher in unfavorable outcome but secondary insults did not remain in the final model of multivariable analysis. Secondary insults occurred frequently during EVT for AIS but the main predictors of outcome were age, NIHSS at admission, and prompt and successful recanalization.

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Data Availability

All relevant data are within the paper.

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Funding

This work was supported by (grant no. S1618_L2_MAZA_01 from Compagnia San Paolo, Torino).

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Authors and Affiliations

  1. Anesthesia and Intensive Care, Department of Surgical Sciences, University of Turin, Turin, Italy

    Anna Teresa Mazzeo, Simone Cappio Borlino, Stefano Malerba, Giulia Catozzi & Claudia Filippini

  2. Anesthesia and Intensive Care, Department of Human Pathology, University of Messina, Via Consolare Valeria, Messina, Italy

    Anna Teresa Mazzeo & Vincenzo Francesco Tripodi

  3. Department of Health Sciences, University of Milan, Milan, Italy

    Simone Cappio Borlino & Giulia Catozzi

  4. Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy

    Andrea Naldi & Paolo Cerrato

  5. Department of Neuroradiology, University of Turin, Turin, Italy

    Mauro Bergui

  6. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy

    Luciana Mascia

Authors
  1. Anna Teresa Mazzeo
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  2. Simone Cappio Borlino
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  3. Stefano Malerba
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  4. Giulia Catozzi
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Contributions

ATM: study conception and design, analysis and interpretation of data, and writing the paper. SCB, SM, and GC: patient recruitment, data collection, and analysis and interpretation of data. CF: conception and design, statistical analysis, and interpretation of data; AN, PC, and MB: data collection, analysis and interpretation of data, and revising the manuscript critically for important intellectual content; LM: study design, analysis and interpretation of data, and revising the article critically for important intellectual content. VFT revising the article critically for important intellectual content. ATM, SCB, SM GC, CF, VFT, AN, PC, MB, and LM: final approval of the version to be published and agreement to be accountable for all aspects of the work thereby ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Anna Teresa Mazzeo.

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Ethical Committee of the AOU Città della Salute e della Scienza of Turin (Italy) approved (CS2/905).

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Mazzeo, A.T., Cappio Borlino, S., Malerba, S. et al. Occurrence of secondary insults during endovascular treatment of acute ischemic stroke and impact on outcome: the SIR-STROKE prospective observational study. Neurol Sci 44, 2061–2069 (2023). https://doi.org/10.1007/s10072-023-06599-x

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