Anesthetic care during thrombectomy for stroke A randomized clinical study
Descrizione riassuntiva dello studio
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)
Intervento studiato
Anesthesia and sedation
(BASEC)
Malattie studiate
Acute ischemic stroke
(BASEC)
- Acute ischemic stroke due to arterial occlusion - Decision for endovascular thrombectomy (BASEC)
Criteri di esclusione
- 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)
Luogo dello studio
Basilea
(BASEC)
Sponsor
non disponibile
Contatto per ulteriori informazioni sullo studio
Informazioni generali
Klinikum rechts der Isar der TU Mnchen
089 4140 9632
alex.brehm@clutterusb.ch(ICTRP)
Informazioni scientifiche
Klinikum rechts der Isar der TU M?nchen
089 4140 9632
alex.brehm@clutterusb.ch(ICTRP)
Nome del comitato etico approvante (per studi multicentrici solo il comitato principale)
Commissione d'etica svizzera nord-ovest/centrale EKNZ
(BASEC)
Data di approvazione del comitato etico
20.07.2023
(BASEC)
ID di studio ICTRP
DRKS00023679 (ICTRP)
Titolo ufficiale (approvato dal comitato etico)
non disponibile
Titolo accademico
Anaesthesiological Care for Thrombectomy in Stroke - ACT in Stroke (ICTRP)
Titolo pubblico
Anaesthesiological Care for Thrombectomy in Stroke (ICTRP)
Malattie studiate
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)
Intervento studiato
Group 1: General anaesthesia during endovascular thrombectomy
Group 2: Sedation (or standby) during endovascular thrombectomy (ICTRP)
Tipo di studio
interventional (ICTRP)
Disegno dello studio
Allocation: Randomized controlled study; Masking: Blinded (masking used); Control: active; Assignment: parallel; Study design purpose: treatment (ICTRP)
Criteri di inclusione/esclusione
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
Endpoint primari e secondari
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)
Data di registrazione
06.04.2021 (ICTRP)
Inclusione del primo partecipante
01.07.2021 (ICTRP)
Sponsor secondari
non disponibile
Contatti aggiuntivi
Andreas Ranft, andreas.ranft@mri.tum.de, 089 4140 9632, Klinikum rechts der Isar der TU Mnchen (ICTRP)
ID secondari
13/21 S-SR (ICTRP)
Risultati-Dati individuali dei partecipanti
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)
Ulteriori informazioni sullo studio
http://drks.de/search/en/trial/DRKS00023679 (ICTRP)
Risultati dello studio
Riepilogo dei risultati
non disponibile
Link ai risultati nel registro primario
non disponibile