Anesthetic care during thrombectomy for stroke A randomized clinical study
Résumé de l'étude
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)
Intervention étudiée
Anesthesia and sedation
(BASEC)
Maladie en cours d'investigation
Acute ischemic stroke
(BASEC)
- Acute ischemic stroke due to arterial occlusion - Decision for endovascular thrombectomy (BASEC)
Critères d'exclusion
- 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)
Lieu de l’étude
Bâle
(BASEC)
Sponsor
non disponible
Contact pour plus d'informations sur l'étude
Informations générales
Klinikum rechts der Isar der TU Mnchen
089 4140 9632
alex.brehm@clutterusb.ch(ICTRP)
Informations scientifiques
Klinikum rechts der Isar der TU M?nchen
089 4140 9632
alex.brehm@clutterusb.ch(ICTRP)
Nom du comité d'éthique approbateur (pour les études multicentriques, uniquement le comité principal)
Ethikkommission Nordwest- und Zentralschweiz EKNZ
(BASEC)
Date d'approbation du comité d'éthique
20.07.2023
(BASEC)
Identifiant de l'essai ICTRP
DRKS00023679 (ICTRP)
Titre officiel (approuvé par le comité d'éthique)
non disponible
Titre académique
Anaesthesiological Care for Thrombectomy in Stroke - ACT in Stroke (ICTRP)
Titre public
Anaesthesiological Care for Thrombectomy in Stroke (ICTRP)
Maladie en cours d'investigation
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)
Intervention étudiée
Group 1: General anaesthesia during endovascular thrombectomy
Group 2: Sedation (or standby) during endovascular thrombectomy (ICTRP)
Type d'essai
interventional (ICTRP)
Plan de l'étude
Allocation: Randomized controlled study; Masking: Blinded (masking used); Control: active; Assignment: parallel; Study design purpose: treatment (ICTRP)
Critères d'inclusion/exclusion
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
Critères d'évaluation principaux et secondaires
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)
Date d'enregistrement
06.04.2021 (ICTRP)
Inclusion du premier participant
01.07.2021 (ICTRP)
Sponsors secondaires
non disponible
Contacts supplémentaires
Andreas Ranft, andreas.ranft@mri.tum.de, 089 4140 9632, Klinikum rechts der Isar der TU Mnchen (ICTRP)
ID secondaires
13/21 S-SR (ICTRP)
Résultats-Données individuelles des participants
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)
Informations complémentaires sur l'essai
http://drks.de/search/en/trial/DRKS00023679 (ICTRP)
Résultats de l'essai
Résumé des résultats
non disponible
Lien vers les résultats dans le registre primaire
non disponible