For all statistical testing, we used the SPSS version 25.0 for Windows (IBM Co., Armonk, NY, USA). Converted patients and patients with unknown anesthesia regimen were excluded from the logistic analysis. For logistic regression analysis, categorical variables were defined as follows: sex male=0, female=1 intravenous thrombolysis treatment no=0, yes=1 successful recanalization no=0, yes=1 type of anesthesia CS=0, GA=1 intracerebral hemorrhage (ICH) no=0, yes=1 tandem lesion no=0, yes=1 posterior circulation stroke no=0, yes =1 pretreatment with oral anticoagulants no=0, yes=1. Binary logistic regression analysis was performed for good outcome (mRS 0-2) and mortality at follow-up, including variables that were either statistically or clinically (or biologically) significant. Clinical characteristics, imaging data, periprocedural times, and outcome parameters were compared across the three groups using the Kruskal-Wallis test or median-test, as appropriate. Normally distributed data were presented as mean±standard deviation and non-normally distributed data as median (interquartile range) or counts and percentages. Ĭontinuous variables were tested for normal distribution using the Kolmogorov-Smirnov test. Here we aimed to analyze the real-life practice of anesthesia regimen in MT-patients from the German Stroke Registry-Endovascular Treatment (GSR-ET) and its impact on complications and outcome.
However, unprotected airways and patient movement are believed to have a negative influence on functional outcome.
Advantages of CS include clinical and neurological monitoring, fewer hemodynamic fluctuations, and potentially shorter procedures. On the other hand, GA may cause a delay before groin puncture and result in complications related to intensive care management leading to an overall delay in the hospital stay. The more optimal periprocedural conditions are said to lead to higher rates of successful reperfusion resulting in better functional outcome. The supposed advantages of GA would be the patients’ immobilization during MT, proper pain management, airway protection and therefore fewer periprocedural complications. Due to the lack of evidence from large clinical trials on this topic, these results have to be interpreted with caution. Data from another registry on anesthesia regimens with 4,429 patients showed, that GA was associated with worse functional outcome, especially when compared with local anesthesia. Contrary to this, a post hoc analysis from 797 patients from the Highly Effective Reperfusion Using Multiple Endovascular Devices (HERMES) Collaboration showed that patients treated without GA had a better 3-month outcome compared to those treated under GA.
A recent meta-analysis from three randomized single-center trials showed an advantage for general anesthesia (GA) compared to conscious sedation (CS) in patients with anterior circulation strokes who underwent MT with respect to 3-month outcome. However, studies on this topic have shown conflicting results. The primary goal of sedation management during MT is to enable the interventionalist to perform the procedure as quickly and safely as possible. While mechanical thrombectomy (MT) is the standard of care in eligible patients with large vessel occlusion (LVO), the appropriate anesthesia regimen is still an unresolved issue. Subgroup analysis for anterior circulation strokes (n=5,808) showed comparable results. In multivariable analysis, GA was associated with reduced achievement of good functional outcome (odds ratio, 0.82 95% confidence interval, 0.71 to 0.94 P=0.004) and increased mortality (OR, 1.42 95% CI, 1.23 to 1.64 P<0.001). The CS-group was more likely to have a good outcome at follow-up (42.1% vs. The CS-group had the lowest rate of periprocedural complications (15.0% vs. 61.0 minutes, P<0.001), but a comparable interval from groin to flow restoration (41.0 minutes vs. Compared to the CA-group, the GA-group had a delay from admission to groin (71.0 minutes vs. Rate of successful reperfusion was similar across all three groups (83.0% vs. 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.