"Real life" impact of anesthesia strategy for mechanical thrombectomy on the delay, recanalization and outcome in acute ischemic stroke patients

Background and purpose. - Choice of anesthesia type on outcome for mechanical thrombectomy (MT) in acute ischemic stroke remains controversial. The goal of our research was to study the impact of anesthesia strategy on the delay, angiographic and neurological outcome of MT performed under general anesthesia (GA) vs. conscious sedation (CS). Methods. - This prospective, single-center observational study included patients with anterior circulation large vessel occlusion (ACLVO) strokes treated with MT within 6 hours of symptom onset. All time metrics were evaluated. Angiographic and clinical outcomes were assessed by recanalization rate (mTICI) and 3-month functional independence (mRs). Complications and mortality rate were recorded as safety outcomes. Results. - In total, 303 consecutive thrombectomies were performed, 86.8% under GA. NIHSS was higher in GA, with median of 19.0 for GA and 16.5 for CS (P= 0.049). Median time from arrival in hospital (door) to groin puncture was 83 min (IQR = 45.0-109.5) for GA compared to 72 min (IQR = 35.0-85.3) for CS, P= 0.170). Median time from arrival in the angiosuite to groin puncture was 20 min (IQR= 15.0-29.0) for GA compared to 15 min (IQR = 10.0-20.0) for CS, P= 0.017). There were no significant differences in recanalization time metrics, successful revascularization rate, functional independence and mortality rate at three months. Conclusions. - GA induced a 5 to 10 minutes delay for groin puncture, without impact on recanalization time metrics, or neurological outcome at 3 months. Our results demonstrate that a well -organized workflow is associated with reasonable delay in performing GA for MT, without effect on outcome compared to sedation. (C) 2018 Elsevier Masson SAS. All rights reserved.