Anesthetic care during thrombectomy for stroke A randomized clinical study
Zusammenfassung der Studie
Endovascular thrombectomy - a minimally invasive procedure to reopen cerebral vessels - is the standard treatment for stroke due to a vascular occlusion in the brain. According to current knowledge, sedation and anesthesia are equivalent regarding treatment outcomes during endovascular thrombectomy. Both sedation and anesthesia are routinely employed by the physicians caring for you. Anesthesia eliminates consciousness and pain perception and usually also respiration. For patients to be ventilated, either a ventilation tube (endotracheal tube) is inserted into their trachea or a laryngeal mask (laryngeal mask, which is a tube with an inflatable cuff at the end) is placed in front of the laryngeal opening. During sedation, calming or pain-relieving medications are given to make patients calm and drowsy or to sleep through the procedure. Breathing may be slightly affected, but ventilation is not required. If sedation is insufficient or breathing becomes too weak, a switch to anesthesia may also be made. Patients are randomly assigned to one of the two study groups. Depending on the assignment, anesthesia or sedation was used for performing the endovascular thrombectomy. A description of this study can also be found at http://www.actinstroke.de.
(BASEC)
Untersuchte Intervention
Anesthesia and sedation
(BASEC)
Untersuchte Krankheit(en)
Acute ischemic stroke
(BASEC)
- Acute ischemic stroke due to arterial occlusion - Decision for endovascular thrombectomy (BASEC)
Ausschlusskriterien
- Suspected technical difficulties - Onset of stroke in the hospital or worsening of a stroke in the hospital - Mild neurological deficit - Required general anesthesia or endotracheal intubation - Severe agitation - Contraindication for general anesthesia - Suspected difficult airway - Age < 18 years (BASEC)
Studienstandort
Basel
(BASEC)
Sponsor
nicht verfügbar
Kontakt für weitere Auskünfte zur Studie
Allgemeine Auskünfte
Klinikum rechts der Isar der TU Mnchen
089 4140 9632
alex.brehm@clutterusb.ch(ICTRP)
Wissenschaftliche Auskünfte
Klinikum rechts der Isar der TU M?nchen
089 4140 9632
alex.brehm@clutterusb.ch(ICTRP)
Name der bewilligenden Ethikkommission (bei multizentrischen Studien nur die Leitkommission)
Ethikkommission Nordwest- und Zentralschweiz EKNZ
(BASEC)
Datum der Bewilligung durch die Ethikkommission
20.07.2023
(BASEC)
ICTRP Studien-ID
DRKS00023679 (ICTRP)
Offizieller Titel (Genehmigt von der Ethikkommission)
nicht verfügbar
Wissenschaftlicher Titel
Anaesthesiological Care for Thrombectomy in Stroke - ACT in Stroke (ICTRP)
Öffentlicher Titel
Anaesthesiological Care for Thrombectomy in Stroke (ICTRP)
Untersuchte Krankheit(en)
I63.5
I63.2Cerebral infarction due to unspecified occlusion or stenosis of cerebral arteriesCerebral infarction due to unspecified occlusion or stenosis of precerebral arteriesI63.5I63.2 (ICTRP)
Untersuchte Intervention
Group 1: General anaesthesia during endovascular thrombectomy
Group 2: Sedation (or standby) during endovascular thrombectomy (ICTRP)
Studientyp
interventional (ICTRP)
Studiendesign
Allocation: Randomized controlled study; Masking: Blinded (masking used); Control: active; Assignment: parallel; Study design purpose: treatment (ICTRP)
Ein-/Ausschlusskriterien
Inclusion criteria: Acute ischemic stroke due to arterial occlusion in the anterior cerebral circulation (i. e., internal carotid artery and/or middle cerebral artery and/or anterior cerebral artery), decision for endovascular thrombectomy (ICTRP)
Exclusion criteria: Suspected procedural technical difficulties while reaching the target occlusion, isolated extracranial arterial occlusion, in-hospital onset of stroke or in-hospital worsening of symptoms, mild neurological deficit (NIH stroke scale < 5), mandatory general anaesthesia or endotracheal intubation (e.g., due to airway obstruction that cannot be controlled with naso- or oropharyngeal tubes, vomiting with risk of tracheobronchial aspiration, severe agitation (Richmond Agitation Sedation Scale +3 or +4), contraindication to general anaesthesia, such as manifest or expected haemodynamic instability (e.g., shock, or known severe aortic stenosis), or COPD with home oxygen, suspected difficult airway, inclusion in another interventional study, age < 18 years
Primäre und sekundäre Endpunkte
After 90 days: Proportion of patients with mRS less than or equal to mRS before stroke or within 0�2 (ICTRP)
Functional outcome at 30 and 90 days using the full mRS; mortality at 30 and 90 days; extent of reperfusion after ET (as graded by interventionalist using an ordinal score); final infarct size (derived from study-specific MRI or routine cCT); neurological symptoms (NIH stroke scale) at 24 hours and 7 days (or discharge, if earlier); time from start of anaesthesia care to puncture for arterial sheath placement; time from arterial puncture to reperfusion (or, in case of futility, last attempt to remove clot); proportion of patients whose mean arterial pressure dropped 20 % or more of pre-procedural values before recanalization; frequency of conversion from PS to GA: proportion of patients primarily treated awake or with PS that were subsequently treated with GA (ICTRP)
Registrierungsdatum
06.04.2021 (ICTRP)
Einschluss des ersten Teilnehmers
01.07.2021 (ICTRP)
Sekundäre Sponsoren
nicht verfügbar
Weitere Kontakte
Andreas Ranft, andreas.ranft@mri.tum.de, 089 4140 9632, Klinikum rechts der Isar der TU Mnchen (ICTRP)
Sekundäre IDs
13/21 S-SR (ICTRP)
Angaben zur Verfügbarkeit von individuellen Teilnehmerdaten
YesThe anonymised pooled data set can be made available for secondary analyses together with the study protocol. For this purpose, a specific request must be made to the steering committee in the form of a detailed study protocol after the initial publication. Prior to submission for publication, each article derived from the pooled data will be reviewed by the steering committee. (ICTRP)
Weitere Informationen zur Studie
http://drks.de/search/en/trial/DRKS00023679 (ICTRP)
Ergebnisse der Studie
Zusammenfassung der Ergebnisse
nicht verfügbar
Link zu den Ergebnissen im Primärregister
nicht verfügbar