The Construction of a Predictive Scale for Emergency Conversion to General Anesthesia during Mechanical Thrombectomy for Acute Ischemic Stroke

doi:10.3969/j.issn.1673-5765.2025.03.009

Abstract

Abstract: Objective To construct a predictive scale for emergency conversion to general anesthesia during mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS).
Methods Patients with AIS who received MT at the First Affiliated Hospital with Nanjing Medical University from January 2020 to December 2023 were retrospectively included. They were categorized into two groups based on the anesthesia approach: the local anesthesia/monitored anesthesia care (LA/MAC) group and the emergency conversion to general anesthesia group. Multivariate logistic regression analysis was performed to determine the risk factors for emergency conversion to general anesthesia during MT. The scores were assigned to each risk factor based on the results of multivariate logistic regression analysis, and the predictive scale was subsequently developed.
Results A total of 864 patients with AIS were included, including 803 patients (92.9%) in the LA/MAC group and 61 patients (7.1%) in the emergency conversion to general anesthesia group. Multivariate logistic regression analysis showed that NIHSS score≥15 points (OR 1.53, 95%CI 1.27-1.78), ASPECTS<6 points (OR 1.40, 95%CI 1.21-1.70), aphasia (OR 1.62, 95%CI 1.30-1.91), and vertebrobasilar artery occlusion (OR 2.21, 95%CI 1.82-2.96) were independently associated with emergency conversion to general anesthesia during MT. Based on the above four independent risk factors, an emergency conversion to general anesthesia predictive scale was developed [NIHSS score≥15 points (1 point), ASPECTS<6 points (1 point), aphasia (1 point), and vertebrobasilar artery occlusion (2 points)]. The optimal cutoff value of the scale for predicting emergency conversion to general anesthesia in AIS patients receiving MT was 3 points. When the scale score was≥3 points, the AUC was 0.853, and the sensitivity, the specificity, and the negative predictive value for predicting emergency conversion to general anesthesia were 0.892, 0.813, and 0.982, respectively.
Conclusions The emergency conversion to general anesthesia predictive scale constructed in this study has good predictive value for emergency conversion to general anesthesia during MT in patients with AIS.

Key words: Stroke; Mechanical thrombectomy; Anesthesia; Emergency conversion to general anesthesia; Prediction

摘要： 目的构建急性缺血性卒中（acute ischemic stroke，AIS）患者机械取栓术中紧急全身麻醉转换的预测量表。
方法回顾性纳入2020年1月—2023年12月于南京医科大学第一附属医院接受机械取栓治疗的AIS患者。依据麻醉方式分为局部麻醉/监测麻醉管理组和紧急全身麻醉转换组。采用多因素logistic回归分析机械取栓术中紧急全身麻醉转换的危险因素，并基于多因素logistic回归分析结果对各危险因素进行赋分，建立预测量表。
结果共纳入接受机械取栓治疗的AIS患者864例，其中局部麻醉/监测麻醉管理组803例（92.9%），紧急全身麻醉转换组61例（7.1%）。多因素logistic回归分析显示NIHSS评分≥15分（OR 1.53，95%CI 1.27～1.78）、ASPECTS<6分（OR 1.40，95%CI 1.21～1.70）、失语（OR 1.62，95%CI 1.30～1.91）及椎基底动脉闭塞（OR 2.21，95%CI 1.82～2.96）与机械取栓术中紧急全身麻醉转换独立相关。基于上述4个独立危险因素构建紧急全身麻醉转换预测量表[NIHSS评分≥15分（1分）、ASPECTS<6分（1分）、失语（1分）和椎基底动脉闭塞（2分）]。该量表预测接受机械取栓治疗的AIS患者术中紧急全身麻醉转换的最佳截断值为3分。当量表评分≥3分时，AUC为0.853，预测紧急全身麻醉转换的敏感度为0.892，特异度为0.813，阴性预测值为0.982。
结论本研究所构建的紧急全身麻醉转换预测量表对AIS患者机械取栓术中紧急全身麻醉转换具有良好的预测价值。

关键词: 卒中; 机械取栓; 麻醉; 紧急全身麻醉转换; 预测

CLC Number:

LI Chuanyou, SHENG Lei, GUO Xueyan, LIU Yuanyue. The Construction of a Predictive Scale for Emergency Conversion to General Anesthesia during Mechanical Thrombectomy for Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2025, 20(3): 320-327.

李传游, 盛蕾, 郭雪艳, 刘元月. 急性缺血性卒中机械取栓术中紧急全身麻醉转换的预测量表构建[J]. 中国卒中杂志, 2025, 20(3): 320-327.

References

[1] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组，中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性卒中早期血管内介入诊疗指南2022[J]. 中华神经科杂志，2022，55（6）：565-580.
Chinese Society of Neurology，Chinese Stroke Society，Neurovascular Intervention Group of Chinese Society of Neurology. Chinese guidelines for the endovascular treatment of acute ischemic stroke 2022[J]. Chin J Neurol，2022，55（6）：565-580.
[2] 梁发，吴侑煊，王鑫焱，等. 急性缺血性脑卒中血管内治疗麻醉进展[J]. 国际麻醉学与复苏杂志，2022，43（10）：1079-1086.
LIANG F，WU Y X，WANG X Y，et al. Advances in anesthesia for intravascular treatment of acute ischemic stroke[J]. Int J Anesth Resus，2022，43（10）：1079-1086.
[3] MAURICE A，EUGÈNE F，RONZIÈRE T，et al. General anesthesia versus sedation，both with hemodynamic control，during intraarterial treatment for stroke：the GASS randomized trial[J]. Anesthesiology，2022，136（4）：567-576.
[4] LIANG F，WU Y X，WANG X Y，et al. General anesthesia vs. conscious sedation for endovascular treatment in patients with posterior circulation acute ischemic stroke：an exploratory randomized clinical trial[J]. JAMA Neurol，2023，80（1）：64-72.
[5] 蔡媛. 急性缺血性卒中血管内治疗麻醉方式之选[J]. 中国卒中杂志，2019，14（5）：495-496.
CAI Y. Anesthesia selection for endovascular treatment in acute ischemic stroke[J]. Chin J Stroke，2019，14（5）：495-496.
[6] RUSY D A，HOFER A，RASMUSSEN M，et al. Assessment of anesthesia practice patterns for endovascular therapy for acute ischemic stroke：a Society for Neuroscience in Anesthesiology and Critical Care（SNACC）member survey[J]. J Neurosurg Anesthesiol，2021，33（4）：343-346.
[7] GERALDINI F，DE CASSAI A，NAPOLI M，et al. Risk factors for general anesthesia conversion in anterior circulation stroke patients undergoing endovascular treatment[J]. Cerebrovasc Dis，2022，51（4）：481-487.
[8] BYRAPPA V，MANOHARA N，JOHN S，et al. Factors influencing the need for emergent conversion to general anesthesia during mechanical thrombectomy in acute anterior circulation stroke—a retrospective observational study[J/OL]. J Clin Neurosci，2023，116：20-26[2024-12-20]. https://doi.org/10.1016/j.jocn.2023.08.007.
[9] VON KUMMER R，BRODERICK J P，CAMPBELL B C，et al. The Heidelberg bleeding classification：classification of bleeding events after ischemic stroke and reperfusion therapy[J]. Stroke，2015，46（10）：2981-2986.
[10] SIMONSEN C Z，SCHÖNENBERGER S，HENDÉN P L，et al. Patients requiring conversion to general anesthesia during endovascular therapy have worse outcomes：a post hoc analysis of data from the SAGA collaboration[J]. AJNR Am J Neuroradiol，2020，41（12）：2298-2302.
[11] SIMONSEN C Z，YOO A J，SØRENSEN L H，et al. Effect of general anesthesia and conscious sedation during endovascular therapy on infarct growth and clinical outcomes in acute ischemic stroke：a randomized clinical trial[J]. JAMA Neurol，2018，75（4）：470-477.
[12] 梁发，吴侑煊，王鑫焱，等. 全身麻醉转化对急性脑卒中患者机械取栓术后神经功能的影响[J]. 首都医科大学学报，2023，44（2）：237-243.
LIANG F，WU Y X，WANG X Y，et al. Effects of emergency conversion to general anesthesia on neurological outcomes of patients with acute ischemic stroke undergoing mechanical thrombectomy[J]. Journal of Capital Medical University，2023，44（2）：237-243.
[13] SPOSATO L A，HILZ M J，ASPBERG S，et al. Post-stroke cardiovascular complications and neurogenic cardiac injury：JACC state-of-the-art review[J]. J Am Coll Cardiol，2020，76（23）：2768-2785.
[14] BUCKLEY B J R，HARRISON S L，HILL A，et al. Stroke-heart syndrome：incidence and clinical outcomes of cardiac complications following stroke[J]. Stroke，2022，53（5）：1759-1763.
[15] 刘潇，王雷. 卒中合并急性冠脉综合征的研究进展[J]. 实用心脑肺血管病杂志，2020，28（3）：113-117.
LIU X，WANG L. Research progress on stroke accompanied with acute coronary syndrome[J]. Pract J Cardiac Cereb Pneum Vasc Dis，2020，28（3）：113-117.
[16] WESTENDORP W F，DAMES C，NEDERKOORN P J，et al. Immunodepression，infections，and functional outcome in ischemic stroke[J]. Stroke，2022，53（5）：1438-1448.
[17] HUO X C，MA G T，TONG X，et al. Trial of endovascular therapy for acute ischemic stroke with large infarct[J]. N Engl J Med，2023，388（14）：1272-1283.
[18] YOSHIMURA S，SAKAI N，YAMAGAMI H，et al. Endovascular therapy for acute stroke with a large ischemic region[J]. N Engl J Med，2022，386（14）：1303-1313.
[19] SARRAJ A，HASSAN A E，ABRAHAM M G，et al. Trial of endovascular thrombectomy for large ischemic strokes[J]. N Engl J Med，2023，388（14）：1259-1271.
[20] YU S，WANG X C，GUO Z L，et al. Basilar artery occlusion location and clinical outcome：data from the ATTENTION multicenter registry[J]. J Neurointerv Surg，2024，16（10）：981-985.
[21] LE TERRIER C，SIGAUT S，ABOU ARAB O，et al. Anaesthetic and peri-operative management for thrombectomy procedures in stroke patients[J/OL]. Anaesth Crit Care Pain Med，2023，42（5）：101293[2024-12-20]. https://doi.org/10.1016/j.accpm.2023.101293.