Purpose

Endovascular therapy (EVT) of large-vessel occlusion in acute ischemic stroke (AIS) may be performed in general anesthesia (GA) or conscious sedation (CS). We intended to determine the contribution of ischemic cerebral lesion sites on the physician’s decision between GA and CS using voxel-based lesion symptom mapping (VLSM).

Methods

In a prospective local database, we sought patients with documented AIS and EVT. Age, stroke severity, lesion volume, vigilance, and aphasia scores were compared between EVT patients with GA and CS. The ischemic lesions were analyzed on CT or MRI scans and transformed into stereotaxic space. We determined the lesion overlap and assessed whether GA or CS is associated with specific cerebral lesion sites using the voxel-wise Liebermeister test.

Results

One hundred seventy-nine patients with AIS and EVT were included in the analysis. The VLSM analysis yielded associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas. Stroke severity and lesion volume were significantly higher in the GA group. The prevalence of aphasia and aphasia severity was significantly higher and parameters of vigilance lower in the GA group.

Conclusions

The VLSM analysis showed associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas including the thalamus that are known to cause neurologic deficits, such as aphasia or compromised vigilance, in AIS-patients with EVT. Our data suggest that higher disability, clinical impairment due to neurological deficits like aphasia, or reduced alertness of affected patients may influence the physician’s decision on using GA in EVT.

中文翻译：

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血管内再通治疗的麻醉方法取决于急性缺血性卒中的病变部位

目的

急性缺血性卒中 (AIS) 大血管闭塞的血管内治疗 (EVT) 可在全身麻醉 (GA) 或清醒镇静 (CS) 下进行。我们打算使用基于体素的病变症状映射 (VLSM) 来确定缺血性脑病变部位对医生在 GA 和 CS 之间的决定的贡献。

方法

在一个前瞻性的本地数据库中，我们寻找有记录的 AIS 和 EVT 的患者。比较 GA 和 CS 的 EVT 患者的年龄、卒中严重程度、病变体积、警惕性和失语症评分。缺血性病变在 CT 或 MRI 扫描上进行分析，并转化为立体空间。我们确定了病变重叠，并使用体素 Liebermeister 检验评估了 GA 或 CS 是否与特定的脑病变部位相关。

结果

179 名 AIS 和 EVT 患者被纳入分析。VLSM 分析得出 GA 与左侧大脑中动脉区域和后循环区域的缺血性病变之间的关联。GA 组的卒中严重程度和病变体积显着更高。GA 组的失语症患病率和失语症严重程度显着较高，而警觉性参数较低。

结论

VLSM 分析显示 GA 与左半球大脑中动脉区域和后循环区域（包括丘脑）的缺血性病变之间存在关联，这些区域已知会导致患有 EVT 的 AIS 患者的神经功能缺损，例如失语或警觉性下降。我们的数据表明，更高的残疾、由于失语症等神经缺陷引起的临床损伤或受影响患者的警觉性降低可能会影响医生在 EVT 中使用 GA 的决定。