General Anesthesia versus Conscious Sedation in Mechanical Thrombectomy

Abstract

Background and Purpose Anesthesia regimen in patients undergoing mechanical thrombectomy (MT) is still an unresolved issue.Methods We compared the effect of anesthesia regimen using data from the German Stroke Registry-Endovascular Treatment (GSR-ET) between June 2015 and December 2019. Degree of disability was rated by the modified Rankin Scale (mRS), and good outcome was defined as mRS 0–2. Successful reperfusion was assumed when the modified thrombolysis in cerebral infarction scale was 2b–3.Results Out of 6,635 patients, 67.1% (n=4,453) patients underwent general anesthesia (GA), 24.9% (n=1,650) conscious sedation (CS), and 3.3% (n=219) conversion from CS to GA. Rate of successful reperfusion was similar across all three groups (83.0% vs. 84.2% vs. 82.6%, <i>P</i>=0.149). Compared to the CA-group, the GA-group had a delay from admission to groin (71.0 minutes vs. 61.0 minutes, <i>P</i><0.001), but a comparable interval from groin to flow restoration (41.0 minutes vs. 39.0 minutes). The CS-group had the lowest rate of periprocedural complications (15.0% vs. 21.0% vs. 28.3%, <i>P</i><0.001). The CS-group was more likely to have a good outcome at follow-up (42.1% vs. 34.2% vs. 33.5%, <i>P</i><0.001) and a lower mortality rate (23.4% vs. 34.2% vs. 26.0%, <i>P</i><0.001). In multivariable analysis, GA was associated with reduced achievement of good functional outcome (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.71 to 0.94; <i>P</i>=0.004) and increased mortality (OR, 1.42; 95% CI, 1.23 to 1.64; <i>P</i><0.001). Subgroup analysis for anterior circulation strokes (n=5,808) showed comparable results.Conclusions We provide further evidence that CS during MT has advantages over GA in terms of complications, time intervals, and functional outcome.

General Anesthesia versus Sedation, Both with Hemodynamic Control, during Intraarterial Treatment for Stroke: The GASS Randomized Trial

“…More hemodynamic stability was reported in retrospective studies. [5][6][7] Studies published thus far report controversial results: conscious sedation is associated with better outcomes [8][9][10] in some studies; the two techniques have similar outcomes in other studies. [11][12][13][14] A meta-analysis including the first three randomized controlled trials on the subject recommended systematic study of the relationship that stroke and treatment-related variables have with outcomes after endovascular therapy.…”

“…10 The difference between profound conscious sedation and light general anesthesia has not always been clearly identified in previous studies. 11 Recent data from the German Stroke Registry favored conscious sedation over general anesthesia with a better functional outcome 9 ; however, neither general anesthesia and conscious sedation protocols nor intraprocedural hemodynamic management was reported. Unlike most previous studies, a standardized anesthesia protocol was applied in both groups in our study and resulted in a similar outcome evaluated via modified Rankin score at 3 months.…”

Late Thrombectomy in Clinical Practice

“…Results of previous reports are controversial regarding general anesthesia (GA) versus conscious sedation (CS) [28]. Considering that most patients in our cohort were treated under general anesthesia, factors such as arterial hypotension, effects of the anesthetics, and others may have contributed to the comparatively poor clinical outcome of our study in addition to the factors discussed [29].…”

Course of Early Neurologic Symptom Severity after Endovascular Treatment of Anterior Circulation Large Vessel Occlusion Stroke: Association with Baseline Multiparametric CT Imaging and Clinical Parameters

“…All patients were treated on a biplane angiography system (Artis Q, Siemens Healthineers, Forchheim, Germany) with continuous anesthesia support, applying either conscious sedation (CS) or general anesthesia (GA) and maintaining sufficient mean arterial blood pressure. The decision between CS and GA was made in consensus between the interventional neuroradiologist, the neurologist on call and the anesthesiologist according to foreseeable patient compliance and patient cardiopulmonary status with conscious sedation as the preferred approach [ 28 ]. A transfemoral access with the co-axial use of 8F guiding catheters and intermediate catheters (usually SOFIA, MicroVention, Tustin, CA, USA or Catalyst, Stryker, Fremont, CA, USA) was the standard of care, aiming at direct thrombus aspiration first, which—if unsuccessful—was converted to stent-retriever based thrombectomy with various approved stent retrievers (Solitaire, Trevo, Preset).…”