North American SOLITAIRE Stent-Retriever Acute Stroke Registry

Abstract

Background and Purpose-Previous work that predated the availability of the safer stent-retriever devices has suggested that general anesthesia (GA) may have a negative impact on outcomes in patients with acute ischemic stroke undergoing endovascular therapy. Methods

Conscious Sedation versus General Anesthesia during Endovascular Acute Ischemic Stroke Treatment: A Systematic Review and Meta-Analysis

“…12,16,17,25,27 The use of general anesthesia was independently associated with worse outcomes despite comparable rates of recanalization among patients included in the North American SOLITAIRE Acute Stent Retriever Registry. 28 One recently published study demonstrated that Ͼ80% of patients undergoing mechanical thrombectomy could be safely treated while under conscious sedation, with high rates of good neurologic outcome. 29 These studies, along with the findings from our study, suggest that conscious sedation is safe and effective in the setting of mechanical thrombectomy for acute ischemic stroke and should be preferred when deemed feasible.…”

Anesthetic Care for Acute Ischemic Stroke: Facts and Aspirations

“…For example, one multicenter study showed that GA was associated with worse functional outcomes as assessed by the mRS than monitored anesthesia care (MAC), based on data from 980 patients who underwent mechanical recanalization (13). Other retrospective studies have come to similar conclusions, with GA associated with worse functional outcomes (i.e., a mRS score >2) (14,15), parenchymal hemorrhage (16), and higher in-hospital mortality (16). A recent metaanalysis of nine studies with 1956 patients found that GA had a lower odds ratio (OR) for good functional outcome (OR= 0.43; P<0.01) and successful recanalization (OR=0.49; P< 0.01), and a higher OR for mortality (OR=2.59; P<0.01) and respiratory complications (OR= 2.09; P<0.01) (17).…”

“…Patients receiving GA may harbor a cerebral infarct that is more extensive and advanced, are unable to cooperate or protect their airways, or have other major comorbidities. Indeed, in many of these retrospective studies, patients receiving GA had higher pre-procedural National Institutes of Health Stroke Scale (NI-HSS) scores, indicating that they had more symptomatic strokes prior to endovascular intervention (13)(14)(15). The difference in baseline neurological status is an independent predictor of worse outcomes, including death (14,16).…”

“…The data on the time used for anesthesia preparation have been mixed, with some studies showing GA taking a longer time from the start of the case to groin puncture (16) while others showing MAC taking longer (15), and still other studies finding no significant differences in the time needed before the first incision…”

Role of Anesthesia for Endovascular Treatment of Ischemic Stroke

“…The available literature 3,4,[8][9][10][11][12][13][14][15][16][17] suggests that patients who receive GA actually do worse than those who receive CS or monitored anesthesia care. However, it should be recognized that the majority of the retrospective studies report a higher stroke severity in the GA-treated group of patients compared with non-GA patients as measured by the National Institutes of Health Stroke Scale (NIHSS).…”