Role of anesthesia in endovascular stroke therapy

Abstract

Retrospective reports, and the 2015 American Heart Association/American Stroke Association Guideline (focused update of the 2013 guidelines for the early management of patients with AIS regarding endovascular treatment) based on these reports, are in favor of sedation (conscious sedation) over general anesthesia for endovascular stroke thrombectomy. However, the two randomized controlled prospective studies published provide inconclusive evidence as to the best anesthetic practice for endovascular stroke therapy. More randomized clinical trials are needed to optimize anesthetic patient care in AIS.

Effect of supraglottic airway devices versus endotracheal intubation general anesthesia on outcomes in patients undergoing mechanical thrombectomy

“…Recently, GA with SAD has been applied in the interventional neuroradiology procedures given its hemodynamic stability, especially during induction and end of anesthesia [35] . Previous studies reported that even slight BP fluctuations before recanalization may be harmful in patients with AIS for whom cerebral blood flow is highly dependent on cerebral perfusion pressure and cerebral autoregulation is seriously damaged during MT [36,37] . We recorded both stable hemodynamics and higher lowest diastolic blood pressure and lowest systolic blood pressure during MT in the SAD group in our study as well as less consumption of vasoactive agents.…”

“…[ 35 ] Previous studies reported that even slight BP fluctuations before recanalization may be harmful in patients with AIS for whom cerebral blood flow is highly dependent on cerebral perfusion pressure and cerebral autoregulation is seriously damaged during MT. [ 36 , 37 ] We recorded both stable hemodynamics and higher lowest diastolic blood pressure and lowest systolic blood pressure during MT in the SAD group in our study as well as less consumption of vasoactive agents. Previous studies have reported that lower periprocedural lowest diastolic blood pressure, high BP variability, and higher cumulative dose of norepinephrine were independently associated with poorer outcome because of its deleterious impact on the collateral circulation with no improved blood flow to the ischemic penumbra.…”

Long-Term Risk Factors for Intracranial In-Stent Restenosis From a Multicenter Trial of Stenting for Symptomatic Intracranial Artery Stenosis Registry in China

“…Management of anesthesia in the endovascular procedure for non-acute stroke patients with ICAS was not discussed in recent literature. Although more RCTs or other trials have been published since 2015 on mechanical thrombectomy for acute stroke with large vessel occlusion, the feasibility and safety of any type of anesthesia, including general anesthesia, conscious sedation, or local anesthesia, are currently in doubt (22,23). According to this study, ISR in groups between patients who underwent intubation and local anesthesia was 17.6%, 13/74, vs. 33.3%, 11/33, P = 0.003, respectively.…”

Anaesthetic and peri-operative management for thrombectomy procedures in stroke patients

“…In a systematic review with meta-analysis, Wang et al identified lung disease, atelectasis, prolonged mechanical ventilation, low GCS score and inability to execute certain orders (closing the eyes, in particular), ''thick'' secretions and altered gag reflex as factors predictive of extubation failure in neurologic intensive care [98]. However, inability to execute other types of orders was not found to be predictive of extubation failure [98].…”