Article Figures & Data
- Figure 1
Anaesthesia technique-based analysis of the participant screening flow chart from the ANGEL-ASPECT Trial. ASPECT, Alberta Stroke Programme Early CT Score; PSM, propensity score matching.
- Figure 2
Systolic blood pressure (SBP) at critical time points. (A) After groin puncture. (B) After final angiography. GA, general anaesthesia.
- Figure 3
Distribution of 90-day mRS scales between the general and non-general anaesthesia groups. (A) Initial cohort. (B) Propensity score matching cohort. mRS, modified Rankin scale.
- Figure 4
Exploratory subgroup analysis of the primary outcome. ASPECTS, Alberta Stroke Programme Early CT score; GA, general anaesthesia; NIHSS, National Institutes of Health Stroke Scale.
- Table 1
Baseline characteristics
Characteristics General anaesthesia
(N=84)Non-general anaesthesia
(N=146)P value Missing, n Age, median (IQR), year 69 (60–74) 68 (61–73) 1.00 0 Male sex, no. (%) 47 (56.0) 88 (60.3) 0.52 0 Medical history, no. (%) Hypertension 49 (58.3) 87 (60.0) 0.85 0 Diabetes mellitus 16 (19.1) 27 (18.5) 0.92 0 Hyperlipidaemia 4 (4.8) 9 (6.2) 0.66 0 Atrial fibrillation 23 (27.4) 34 (23.3) 0.49 0 Ischaemic stroke 14 (16.7) 24 (16.4) 0.96 0 Coronary heart disease 13 (15.5) 24 (16.4) 0.85 0 NIHSS score (IQR) 17 (14–20) 16 (13–19) 0.12 0 ASPECTS value based on CT Median value (IQR) 3 (3–4) 3 (3–4) 0.53 0 Distribution, no. (%) 0.91 0 0–2 13 (15.5) 18 (12.3) 3 36 (42.9) 63 (43.2) 4 22 (26.2) 42 (28.8) 5 13 (15.5) 23 (15.8) Infarct-core volume, median (IQR), mL 67.5 (28.5–94) 56 (30–79) 0.09 0 Penumbra volume, median (IQR), mL 183 (144–236) 168 (120–219) 0.28 28 Prestroke mRS, no. (%) 0.99 0 0 76 (90.5) 132 (90.4) 1 8 (9.5) 14 (9.6) Baseline SBP, median (IQR), mm Hg 147 (133–168.5) 143 (128–165) 0.26 0 Admission glucose, median (IQR), mmol/L 7.3 (6.4–8.6) 7.1 (6.0–9.2) 0.51 45 Intravenous thrombolysis, no. (%) 23 (27.4) 42 (28.8) 0.82 0 Occlusion site, no. (%) 0.73 0 ICA 33 (39.3) 51 (34.9) M1 segment 50 (59.5) 94 (64.4) M2 segment 1 (1.2) 1 (0.7) Stroke classification, no. (%) 0.61 0 Atherothrombotic 22 (26.2) 39 (26.7) Cardioembolic 37 (44.1) 72 (49.3) Undetermined and others 25 (29.8) 35 (24.0) Interval between onset and hospital arrival, median (IQR), min 330 (187–649) 348 (205–627) 0.86 0 Interval between onset and first imaging, median (IQR), min 433 (239–700) 391 (252–659) 0.95 0 Onset to randomisation Median (IQR), min 472 (275–746) 427 (306–710) 0.91 0 Distribution, no. (%) 0.56 0 ＜6 hours 32 (38.1) 50 (34.3) 6–24 hour 52 (61.9) 96 (65.8) Interval between onset and puncture, median (IQR), min 519 (321–786) 455 (328–774) 0.78 4 Interval between onset and recanalisation, median (IQR), min 620 (395–890) 558 (426–835) 0.80 4 Interval between puncture and recanalisation, median (IQR), min 78 (51.5–104.5) 72.5 (43-115) 0.48 3 Operative time*, median (IQR), min 142 (110–182) 121 (85–172) 0.03 3 *Operative time is defined as the difference between ‘the time the patient arrives at the catheterisation room’ and ‘the time the patient leaves the catheterisation room’.
ASPECTS, Alberta Stroke Programme Early CT score; ICA, internal carotid artery; M, middle cerebral artery; mRS, modified Rankin scale; NIHSS, National Institutes of Health Stroke Scale; SBP, systolic blood pressure.
- Table 2
Association between anaesthetic techniques and outcomes of interest: general anaesthesia versus non-general anaesthesia
N Unadjusted Adjusted model 1* PSM Missing, n General anaesthesia Non-general anaesthesia Effect size
(95% CI)†Effect size
(95% CI)†Effect size
(95% CI)†84 146 230 230 130 Primary outcome mRS of 0–2 at the 90-day follow-up 23 (27.4) 46 (31.5) 0.82 (0.45 to 1.48) 0.97 (0.51 to –1.86) 0.86 (0.40 to –1.84) 0 Secondary outcomes mRS score at the 90-day follow-up 4 (2-6) 3.5 (2-5) 0.75 (0.47 to 1.20) 0.83 (0.51 to 1.35) 0.70 (0.38 to –1.28) 0 mRS of 0–3 at the 90-day follow-up 36 (42.9) 73 (50.0) 0.75 (0.44 to 1.29) 0.88 (0.48 to 1.60) 0.73 (0.37 to –1.46) 0 36-hour ΔNIHSS 0 (-5–3.5) 1 (-1–4) −2.78 (-5.11 to –0.45) −2.68 (-5.03 to –0.33) −2.42 (–5.68 to 0.85) 0 Change from baseline in infarct volume 65.1 (29.0–143.4) 57.3 (30.8–128.7) 2.85 (−24.15 to 29.86) 1.28 (−26.06 to 28.62) 15.25 (−19.71 to 50.21) 3 Successful reperfusion (mTICI 2b-3) 69 (82.1) 114 (80.3) 1.13 (0.56 to 2.26) 1.11 (0.54 to 2.27) 0.90 (0.37 to 2.22) 4 Safety outcomes Pneumonia 26 (31.0) 25 (17.1) 2.17 (1.15 to 4.08) 2.03 (1.04 to 3.98) 2.42 (1.08 to 5.42) 0 sICH within 48 hours 6 (7.1) 8 (5.5) 1.33 (0.44 to 3.96) 1.18 (0.37 to 3.77) 1.27 (0.33 to 4.96) 0 Any ICH within 48 hours 41 (48.8) 72 (49.3) 0.98 (0.57 to 1.68) 0.94 (0.54 to 1.65) 1.21 (0.60 to 2.41) 0 Death within 90-day 22 (26.2) 27 (18.5) 1.56 (0.82 to 2.97) 1.50 (0.75 to 2.97) 2.38 (0.98 to 5.80) 0 Decompressive hemicraniectomy during hospitalisation 8 (9.5) 9 (6.2) 1.60 (0.59 to 4.32) 1.51 (0.53 to 4.36) 4.42 (0.90 to 21.69) 0 Any procedural complications‡ 7 (8.3) 10 (6.8) 1.19 (0.44 to 3.26) 1.32 (0.47 to 3.71) 1.25 (0.32 to 4.88) 5 *Adjusted for age, prestroke mRS score, baseline NIHSS score, baseline ASPECTS, core infarct volume, time from onset to puncture and receipt of intravenous thrombolysis in the intention-to-treat population.
†The results of the binary logistic regression are reported as ORs with 95% CIs, those of the linear regression are reported as β values with 95% CIs and those of the ordinal logistic regression are reported as cORs with 95% CIs.
‡Procedural complications include arterial dissection, arterial perforation, vasospasm requiring treatment and embolisation in a new territory.
ASPECTS, Alberta Stroke Programme Early CT Score; cOR, crude OR; ICH, intracranial haemorrhage; mRS, modified Rankin scale; mTICI, modified thrombolysis in cerebral infarction; NIHSS, National Institutes of Health Stroke Scale; PSM, propensity score matching; sICH, symptomatic ICH.
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