Local anesthesia versus general anesthesia during endovascular therapy for acute stroke: a propensity score analysis.

Abstract

BACKGROUND:

To date, the choice of optimal anesthetic management during endovascular therapy (EVT) of acute ischemic stroke patients remains subject to debate. We aimed to compare functional outcomes and complication rates of EVT according to the first-line anesthetic management in two comprehensive stroke centers: local anesthesia (LA) versus general anesthesia (GA).

METHODS:

Retrospective analysis of prospectively collected databases, identifying all consecutive EVT for strokes in the anterior circulation performed between January 1, 2018 and December 31, 2018 in two EVT-capable stroke centers. One center performed EVT under LA in the first intention, while the other center systematically used GA. Using propensity score analysis, the two groups underwent 1:1 matching, then procedural metrics, complications, and clinical outcomes were compared. Good outcome was defined as 90 days modified Rankin Scale (mRS) ≤2, and successful recanalization as modified Thrombolysis In Cerebral Ischemia (mTICI) 2b-3.

RESULTS:

During the study period, 219 patients were treated in the LA center and 142 in the GA center. Using the propensity score, 97 patients from each center were matched 1:1 according to the baseline characteristics. Local anesthesia was associated with a significantly lower proportion of good outcome (36.1% vs 52.0%, OR 0.53, 95% CI 0.33 to 0.87; p=0.039), lower rate of successful recanalization (70.1% vs 95.8%, OR 0.13, 95% CI 0.04 to 0.39; p<0.001), and more procedural complications (14.4% vs 3.0%, OR 3.44, 95% CI 1.09 to 14.28; p=0.018). There were no significant differences in 90-day mortality or symptomatic hemorrhagic transformation rates.

CONCLUSIONS:

In this study, systematic use of GA for stroke EVT was associated with better clinical outcomes, higher recanalization rates, and fewer procedural complications compared with patients treated under LA as the primary anesthetic approach.

• Authors: Raoul Pop, François Severac, Emmanuel Happi Ngankou, Oana Harsan, Ioan Martin, Dan Mihoc, Monica Manisor, Mihaela Simu, Salvatore Chibbaro, Valérie Wolff, Roxana Gheoca, Alain Meyer, Julien Pottecher, Gérard Audibert, Anne-Laure Derelle, Romain Tonnelet, Liang Liao, François Zhu, Serge Bracard, René Anxionnat, Sébastien Richard, Rémy Beaujeux, Benjamin Gory
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) Vol. 13 Issue 3 Pg. 207-211 (Mar 2021) ISSN: 1759-8486 [Electronic] England
• PMID: 32487768 (Publication Type: Comparative Study, Journal Article, Multicenter Study)
• Copyright: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Aged
• Aged, 80 and over
• Anesthesia, General (methods)
• Anesthesia, Local (methods)
• Brain Ischemia (diagnostic imaging, therapy)
• Conscious Sedation (methods)
• Endovascular Procedures (methods)
• Female
• Humans
• Male
• Middle Aged
• Propensity Score
• Prospective Studies
• Retrospective Studies
• Stroke (diagnostic imaging, therapy)
• Treatment Outcome