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阻塞引起的。在这些情况下，迅速清除血管中的血块可以扭转患者的症状。对于这种称为血管内血栓切除术的手术，神经放射科医生刺穿股动脉，将导管沿主动脉向上穿到脑动脉中的阻塞处，并试图重新建立流向下游脑组织的血流。为了在脉管系统中安全有效地操纵导管，患者的不动性至关重要。不幸的是，许多中风患者非常害怕和不安，当他们的语言理解能力受损时，他们将完全无法获得口头安慰。在这一点上，麻醉师需要建立适当的干预条件。然而，目前尚不清楚是否镇静与保留自主通气或全身麻醉与控制机械通气是更好地考虑到病人的功能结果三个月后。我们计划进行一项全国性的多中心、前瞻性、随机、对照试验，并进行盲法结局评估来回答这个问题。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切除术期间的全身麻醉增强了卒中患者在损伤后三个月测量的功能结局。

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.