Optimal Ventilation Time After Endovascular Treatment Under General Anesthesia for Acute Ischemic Stroke. a Prospective, Randomized Comparison Between Early Vs Delayed Extubation

Status: Recruiting
Location: See location...
Intervention Type: Other
Study Type: Interventional
Study Phase: Not Applicable
SUMMARY

Although older studies, most of them retrospective in design, advocated sedation over general anesthesia during endovascular treatment for acute ischemic stroke, a recent meta-analysis and randomized studies have shown that general anesthesia is associated with better functional status at 3 months compared with local anesthesia and sedation. In our center, most procedures are performed under general anesthesia, and once the procedure is complete, the patient is transferred intubated and sedated to the ICU. If the patient is hemodynamically and respiratory stable, the patient will be extubated, and will be discharged to the Neurology hospitalization floor. Several factors have been described that may influence the evolution and functional status at three months of patients who have suffered a stroke and have received endovascular treatment, such as the time between the onset of symptoms and admission to the ward for performing the procedure, the use of general anesthesia compared to sedation and local anesthesia, adequate control of blood pressure, the size of the cerebral infarct, or a worse neurological examination at the time of the procedure. In turn, several factors have been described that may influence the success of extubation in a patient who has suffered an acute ischemic stroke and who has required orotracheal intubation, such as the absence of dysarthria, the size of the infarct, the location of the infarction, the NIHSS (National Institutes of health Stroke Scale) or neurological status prior to orotracheal intubation. The investigators do not know, however, whether the time of mechanical ventilation can influence the evolution and functional status at three months of patients who have suffered a stroke and have received endovascular treatment under general anesthesia

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• Adult (age ≥ 18 years)

• Acute ischemic stroke due to large intracranial vessel occlusion demonstrated on CT-angiography in the following anterior circulation locations (occlusion of the internal carotid artery and/or middle cerebral artery in segments M1, M2, M3) within 24 hours of symptom onset.

• Patients admitted with a NIHSS neurological status ≥ 6.

• Patients who received endovascular treatment under general anesthesia (intubated in the interventional radiology room) with satisfactory reperfusion (TICI 2b-2c-3).

• Patients admitted in the intensive care unit (ICU) with mechanical ventilation.

• Written informed consent from the patient or proxy (if present) before inclusion or once possible when patient has been included in a context of emergency.

Locations
Other Locations
Spain
University Clinical Hospital of Santiago de Compostela
RECRUITING
Santiago De Compostela
Contact Information
Primary
Manuel Taboada, Ph.D.
manutabo@yahoo.es
0034981950674
Time Frame
Start Date: 2023-04-18
Estimated Completion Date: 2026-12-31
Participants
Target number of participants: 174
Treatments
Active_comparator: Early extubation
Patients randomized to early extubation, will be extubated \< 6 hours after endovascular treatment under general anesthesia.
Experimental: Delayed extubation
Patients randomized to delayed extubation, will be extubated 6-12 hours after endovascular treatment under general anesthesia.
Related Therapeutic Areas
Sponsors
Leads: Hospital Clinico Universitario de Santiago

This content was sourced from clinicaltrials.gov