Anaesthesiological Care for Endovascular Thrombectomy in Acute Ischaemic Stroke (ACT in Stroke)

大约三分之一的中风是由供应大脑的大动脉闭塞引起的。在这种情况下，迅速从血管中清除血栓可以扭转患者的症状。在这种被称为血管内血栓切除术的过程中，神经放射科医生刺穿股动脉，将导管沿主动脉向上穿过大脑动脉的阻塞处，并试图重建流向下游脑组织的血液。为了安全有效地在血管系统中操作导管，患者的固定是至关重要的。不幸的是，许多急性中风患者受到惊吓和不安，当他们的语言理解能力受损时，他们将完全无法获得言语上的安慰。在这一点上，麻醉师需要为干预建立足够的条件。然而，对于患者三个月后的功能结果，目前尚不清楚是保留自主呼吸的镇静效果好，还是全身麻醉控制机械通气效果好。我们已经计划了一项全国性的多中心、前瞻性、随机、对照试验，并对结果进行盲法评估来回答这个问题。由神经科医生和/或神经放射科医生选择接受血管内血栓切除术的大脑前循环急性闭塞患者，应根据各自中心的标准临床实践随机接受全身麻醉或清醒镇静。我们假设血管内血栓摘除术中的全身麻醉可以提高中风患者在发病三个月后的功能结果。

About one third of strokes is caused by occlusion of a large artery supplying the brain. In those cases, swift removal of the blood clot from the vessel can reverse the patient’s symptoms. For this procedure called endovascular thrombectomy, a neuroradiologist punctures the femoral artery, threads a catheter up the aorta to the obstruction in the cerebral artery, and tries to re-establish blood flow to the brain tissue downstream. In order to safely and effectively manipulate the catheter in the vasculature, the patient’s immobility is crucial. Unfortunately, many patients acutely afflicted by stroke are scared and restless, and when their speech comprehension is impaired, they will be entirely inaccessible to verbal reassurance. At this point, anaesthesiologists are required to establish adequate conditions for the intervention. However, it is yet unclear whether sedation with preserved spontaneous ventilation or general anaesthesia with controlled mechanical ventilation is better with regard to the patient’s functional outcome three months later. We have planned a national multicentre, prospective, randomized, controlled trial with blinded outcome assessment to answer this question. Patients with an acute occlusion in the anterior cerebral circulation that have been selected by a neurologist and/or neuroradiologist to undergo endovascular thrombectomy shall be randomized to receive general anaesthesia or conscious sedation according to standard clinical practice of the respective centre. We hypothesize that general anaesthesia during endovascular thrombectomy enhances stroke patients’ functional outcome measured three months after the insult.