Identificador persistente para citar o vincular este elemento: http://hdl.handle.net/10553/52001
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dc.contributor.authorCampbell, Bruce C.V.en_US
dc.contributor.authorvan Zwam, Wim H.en_US
dc.contributor.authorGoyal, Mayanken_US
dc.contributor.authorMenon, Bijoy K.en_US
dc.contributor.authorDippel, Diederik W.J.en_US
dc.contributor.authorDemchuk, Andrew M.en_US
dc.contributor.authorBracard, Sergeen_US
dc.contributor.authorWhite, Philipen_US
dc.contributor.authorDávalos, Antonien_US
dc.contributor.authorMajoie, Charles B.L.M.en_US
dc.contributor.authorvan der Lugt, Aaden_US
dc.contributor.authorFord, Gary A.en_US
dc.contributor.authorde la Ossa, Natalia Pérezen_US
dc.contributor.authorKelly, Michaelen_US
dc.contributor.authorBourcier, Romainen_US
dc.contributor.authorDonnan, Geoffrey A.en_US
dc.contributor.authorRoos, Yvo B.W.E.M.en_US
dc.contributor.authorBang, Oh Youngen_US
dc.contributor.authorNogueira, Raul G.en_US
dc.contributor.authorDevlin, Thomas G.en_US
dc.contributor.authorvan den Berg, Lucie A.en_US
dc.contributor.authorClarençon, Frédéricen_US
dc.contributor.authorBurns, Paulen_US
dc.contributor.authorCarpenter, Jeffreyen_US
dc.contributor.authorBerkhemer, Olvert A.en_US
dc.contributor.authorYavagal, Dileep R.en_US
dc.contributor.authorPereira, Vitor Mendesen_US
dc.contributor.authorDucrocq, Xavieren_US
dc.contributor.authorDixit, Ananden_US
dc.contributor.authorQuesada, Helenaen_US
dc.contributor.authorEpstein, Jonathanen_US
dc.contributor.authorDavis, Stephen M.en_US
dc.contributor.authorJansen, Olaven_US
dc.contributor.authorRubiera, Martaen_US
dc.contributor.authorUrra, Xabieren_US
dc.contributor.authorMicard, Emilienen_US
dc.contributor.authorLingsma, Hester F.en_US
dc.contributor.authorNaggara, Olivieren_US
dc.contributor.authorBrown, Scotten_US
dc.contributor.authorGuillemin, Francisen_US
dc.contributor.authorMuir, Keith W.en_US
dc.contributor.authorvan Oostenbrugge, Robert J.en_US
dc.contributor.authorSaver, Jeffrey L.en_US
dc.contributor.authorJovin, Tudor G.en_US
dc.contributor.authorHill, Michael D.en_US
dc.contributor.authorMitchell, Peter J.en_US
dc.contributor.authorFransen, Puck SSen_US
dc.contributor.authorBeumer, Debbieen_US
dc.contributor.authorYoo, Albert J.en_US
dc.contributor.authorSchonewille, Wouter J.en_US
dc.contributor.authorVos, Jan Alberten_US
dc.contributor.authorNederkoorn, Paul J.en_US
dc.contributor.authorWermer, Marieke JHen_US
dc.contributor.authorvan Walderveen, Marianne AAen_US
dc.contributor.authorStaals, Julieen_US
dc.contributor.authorHofmeijer, Jeannetteen_US
dc.contributor.authorvan Oostayen, Jacques A.en_US
dc.contributor.authorLycklama à Nijeholt, Geert J.en_US
dc.contributor.authorBoiten, Jelisen_US
dc.contributor.authorBrouwer, Patrick A.en_US
dc.contributor.authorEmmer, Bart J.en_US
dc.contributor.authorde Bruijn, Sebastiaan F.en_US
dc.contributor.authorvan Dijk, Lukas C.en_US
dc.contributor.authorKappelle, Jaapen_US
dc.contributor.authorLo, Rob H.en_US
dc.contributor.authorvan Dijk, Ewoud J.en_US
dc.contributor.authorde Vries, Joosten_US
dc.contributor.authorde Kort, Paul L.M.en_US
dc.contributor.authorvan Rooij, Willem Jan J.en_US
dc.contributor.authorvan den Berg, Jan S.P.en_US
dc.contributor.authorvan Hasselt, Boudewijn A.A.M.en_US
dc.contributor.authorAerden, Leo A.M.en_US
dc.contributor.authorDallinga, René J.en_US
dc.contributor.authorVisser, Marieke C.en_US
dc.contributor.authorBot, Joseph C.J.en_US
dc.contributor.authorVroomen, Patrick C.en_US
dc.contributor.authorEshghi, Omiden_US
dc.contributor.authorSchreuder, Tobien H.C.M.L.en_US
dc.contributor.authorHeijboer, Roel J.J.en_US
dc.contributor.authorKeizer, Koosen_US
dc.contributor.authorTielbeek, Alexander V.en_US
dc.contributor.authorden Hertog, Heleen M.en_US
dc.contributor.authorGerrits, Dick G.en_US
dc.contributor.authorvan den Berg-Vos, Renske M.en_US
dc.contributor.authorKaras, Giorgos B.en_US
dc.contributor.authorSteyerberg, Ewout W.en_US
dc.contributor.authorFlach, Zwennekeen_US
dc.contributor.authorMarquering, Henk A.en_US
dc.contributor.authorSprengers, Marieke E.S.en_US
dc.contributor.authorJenniskens, Sjoerd F.M.en_US
dc.contributor.authorBeenen, Ludo F.M.en_US
dc.contributor.authorvan den Berg, Renéen_US
dc.contributor.authorKoudstaal, Peter J.en_US
dc.date.accessioned2018-11-25T16:36:06Z-
dc.date.available2018-11-25T16:36:06Z-
dc.date.issued2018en_US
dc.identifier.issn1474-4422en_US
dc.identifier.urihttp://hdl.handle.net/10553/52001-
dc.description.abstractBackground: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. Methods: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered. Findings: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09-2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75-3·10, p<0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14-2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low. Interpretation: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons. Funding: Medtronic.en_US
dc.languageengen_US
dc.relation.ispartofThe Lancet Neurologyen_US
dc.sourceThe Lancet Neurology[ISSN 1474-4422],v. 17(1), p. 47-53 (Enero 2018)en_US
dc.subject32 Ciencias médicasen_US
dc.subject320507 Neurologíaen_US
dc.subject.otherBrain Ischemiaen_US
dc.subject.otherAnesthesiaen_US
dc.subject.otherStrokeen_US
dc.subject.otherThrombectomyen_US
dc.titleEffect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient dataen_US
dc.typeinfo:eu-repo/semantics/articleen_US
dc.typeArticleen_US
dc.identifier.doi10.1016/S1474-4422(17)30407-6en_US
dc.identifier.scopus85039561512-
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dc.description.lastpage53en_US
dc.description.firstpage47en_US
dc.relation.volume17en_US
dc.investigacionCiencias de la Saluden_US
dc.type2Artículoen_US
dc.description.numberofpages7en_US
dc.utils.revisionen_US
dc.date.coverdateEnero 2018en_US
dc.identifier.ulpgcen_US
dc.contributor.buulpgcBU-MEDen_US
dc.description.sjr12,285-
dc.description.jcr28,755-
dc.description.sjrqQ1-
dc.description.jcrqQ1-
dc.description.scieSCIE-
item.grantfulltextnone-
item.fulltextSin texto completo-
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