BACKGROUND AND OBJECTIVES Although dexmedetomidine (DEX) is widely administered during endovascular treatment (EVT) to enhance procedural adherence of patients with acute ischemic stroke (AIS) with large vessel occlusion, there is limited research on the association of DEX and outcomes among these patients. Hence, this study aimed to explore the safety and outcomes of DEX during conscious sedation (CS) in a real-world setting among patients undergoing EVT. METHODS This study was an individual patient-level pooled analysis of 2 multicenter randomized clinical trials RESCUE-BT and DEVT. This study included patients who underwent EVT because of occlusion of the internal carotid artery or middle cerebral artery. The DEX group included those receiving intraprocedural DEX for CS, whereas the patients without intraprocedural DEX sedation were categorized into the non-DEX group. The primary outcome was functional independence (modified Rankin Scale score of 0-2 at 90 days). Adjusted odds ratio (aOR) and 95% CI were obtained by logistic regression models. RESULTS A total of 728 patients were included in this study, of whom 308 (42.3%) were female. The median (interquartile range) age was 69 (59-76) years; the median baseline NIH Stroke Scale score was 16 (12-19). Compared with the non-DEX group, the DEX group had a significantly lower rate of functional independence (40.3% vs 51.3%; aOR 0.66; 95% CI 0.46-0.93; p = 0.019). There was a significantly higher rate of unstable procedural hemodynamics in the DEX group (9.7% vs 2.3%; aOR 4.60, 95% CI 2.12-9.99, p < 0.001). In subgroup analysis, similar results were found in intraprocedural DEX-treated patients when compared with local anesthesia or intraprocedural midazolam-treated patients, respectively. DISCUSSION There was a negative association between procedural DEX administration during CS and functional outcomes in patients with AIS receiving EVT in a real-world setting. A larger cohort is warranted to validate our findings. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the use of DEX during EVT of AIS is associated with a worse outcome compared with other agents.

中文翻译：

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在 DEVT 和 RESCUE-BT 试验中，清醒镇静与右美托咪定与接受血栓切除术的中风患者结局的关联。


背景和目标尽管右美托咪定 （DEX） 在血管内治疗 （EVT） 期间被广泛使用，以提高大血管闭塞急性缺血性卒中 （AIS） 患者的手术依从性，但关于 DEX 与这些患者结局的关系的研究有限。因此，本研究旨在探讨 DEX 在接受 EVT 的患者在真实世界环境中清醒镇静 （CS） 期间的安全性和结果。方法 本研究是对 2 项多中心随机临床试验 RESCUE-BT 和 DEVT 的个体患者水平汇总分析。这项研究包括因颈内动脉或大脑中动脉闭塞而接受 EVT 的患者。DEX 组包括接受术中 DEX 治疗 CS 的患者，而未接受术中 DEX 镇静的患者被归类为非 DEX 组。主要结局是功能独立性 （90 天时改良 Rankin 量表评分为 0-2）。通过 logistic 回归模型获得调整比值比 （aOR） 和 95% CI。结果 本研究共纳入 728 例患者，其中 308 例 （42.3%） 为女性。中位（四分位距）年龄为 69 （59-76） 岁;中位基线 NIH 卒中量表评分为 16 （12-19）。与非 DEX 组相比，DEX 组的功能独立性显著降低 （40.3% vs 51.3%;aOR 0.66;95% CI 0.46-0.93;p = 0.019）。DEX 组不稳定程序血流动力学的发生率显著更高 （9.7% vs 2.3%;aOR 4.60,95% CI 2.12-9.99，p < 0.001）。在亚组分析中，与局部麻醉或术中咪达唑仑治疗患者相比，术中 DEX 治疗的患者结果相似。 讨论CS 期间的程序 DEX 给药与在真实环境中接受 EVT 的 AIS 患者的功能结果之间存在负相关。需要一个更大的队列来验证我们的发现。证据分类 本研究提供了 II 类证据，表明与其他药物相比，在 AIS 的 EVT 期间使用 DEX 与更差的结果相关。