Increased Rate of Aspiration Pneumonia and Poor Discharge Outcome Among Acute Ischemic Stroke Patients Following Intubation for Endovascular Treatment

Background An increased risk of aspiration pneumonia among acute ischemic stroke patients following intubation for endovascular treatment may explain the higher rates of poor outcomes among patients requiring general anesthesia compared with those performed under local sedation. Methods Rates of aspiration pneumonia and its contribution to poor outcome at discharge (modified Rankin score >= 3), and in-hospital mortality were analyzed among endovascularly treated acute ischemic stroke patients at two university-affiliated comprehensive stroke centers. Logistic regression model was used to assess the contribution of intubation and aspiration pneumonia on poor outcome after adjusting for potential confounders. Results There were 136 acute ischemic stroke patients who received endovascular treatment: 83 patients received local sedation without intubation and 53 patients were intubated. The rates of aspiration pneumonia were 12 (14%) in endovascularly treated patients not intubated, and 12 (23%) in endovascularly treated intubated patients. Rates of poor outcomes were 46 (55%) in the non-intubated endovascularly treated patients, and 44 (83%) in intubated endovascularly treated patients. After adjusting for age, gender, National Institutes of Health Stroke Scale (NIHSS) score strata, poor outcome at discharge (OR 2.9, 95% CI 1.2-7.4) (P = 0.0243) and in-hospital mortality (OR 4.5, 95% CI 1.5-12.5) (P = 0. 0.0046) were significantly higher among intubated patients. After adjusting for pneumonia, the effect of intubation on poor outcome at discharge (OR 2.7, CI 1.1-7.1) (P = 0.0006) and in-hospital mortality (OR 4.4, CI 1.6-12.5) (P = 0.00051) remained significant in the multivariate model. Conclusions Careful consideration should be exercised when emergently intubating acute ischemic stroke patients for endovascular treatment, because the rate of death and disability appears to be high. This increased rate is not explained by higher rates of subsequent aspiration pneumonia.