Skip to main content
SpringerLink
Log in

General Anesthesia Versus Conscious Sedation in Acute Stroke Treatment: The Importance of Head Immobilization

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

While today mechanical thrombectomy is an established treatment option for main branch occlusions in anterior circulation stroke, there is still an ongoing debate on the kind of anesthesia to be preferred. Introducing a simple method for head stabilization, we analyzed safety and duration of endovascular recanalization procedures under general anesthesia (GA) and conscious sedation (CS).

Methods

We retrospectively identified 84 consecutive patients who underwent mechanical thrombectomy owing to acute anterior circulation stroke. Fifty-three were treated under GA and 31 under CS equipped with a standard cervical collar to reduce head movement. We evaluated recanalization results, in-house time to start recanalization, procedure times, technical and clinical complication rates, and conversion rates from CS to GA.

Results

Recanalization of mTICI ≥2b was achieved in 80 % under CS and in 81 % under GA. Median in-house time to start recanalization for CS was 60 min (IQR 28; 44–72) and 77 min (IQR 23; 68–91) for GA (P = 0.001). Median procedure time under CS was 35 min (IQR 43; 69–25) and 41 min (IQR 43; 66–23) for GA (P = 0.9). No major complications such as ICH occurred in either group, and no conversions from CS to GA were necessary.

Conclusion

Mechanical thrombectomy can be performed faster and safely under CS in combination with simple head immobilization using a standard cervical collar.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Abou-Chebl A, Lin R, Hussain MS, et al. Conscious sedation versus general anesthesia during endovascular therapy for acute anterior circulation stroke: preliminary results from a retrospective, multicenter study. Stroke. 2010;41(6):1175–9.

    Article  CAS  PubMed  Google Scholar 

  2. Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11–20.

    Article  PubMed  Google Scholar 

  3. Brekenfeld C, Mattle HP, Schroth G. General is better than local anesthesia during endovascular procedures. Stroke. 2010;41(11):2716–7.

    Article  PubMed  Google Scholar 

  4. Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–18.

    Article  CAS  PubMed  Google Scholar 

  5. Castano C, Dorado L, Guerrero C, et al. Mechanical thrombectomy with the Solitaire AB device in large artery occlusions of the anterior circulation: a pilot study. Stroke. 2010;41(8):1836–40.

    Article  PubMed  Google Scholar 

  6. Davis MJ, Menon BK, Baghirzada LB, et al. Anesthetic management and outcome in patients during endovascular therapy for acute stroke. Anesthesiology. 2012;116(2):396–405.

    Article  CAS  PubMed  Google Scholar 

  7. Evers SM, Struijs JN, Ament AJ, van Genugten ML, Jager JH, van den Bos GA. International comparison of stroke cost studies. Stroke. 2004;35(5):1209–15.

    Article  PubMed  Google Scholar 

  8. Fasseas P, Orford JL, Panetta CJ, et al. Incidence, correlates, management, and clinical outcome of coronary perforation: analysis of 16,298 procedures. Am Heart J. 2004;147(1):140–5.

    Article  PubMed  Google Scholar 

  9. Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30.

    Article  CAS  PubMed  Google Scholar 

  10. Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet. 2004;363(9411):768–74.

    Article  PubMed  Google Scholar 

  11. John N, Mitchell P, Dowling R, Yan B. Is general anaesthesia preferable to conscious sedation in the treatment of acute ischaemic stroke with intra-arterial mechanical thrombectomy? A review of the literature. Neuroradiology. 2013;55(1):93–100.

    Article  CAS  PubMed  Google Scholar 

  12. Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–306.

    Article  CAS  PubMed  Google Scholar 

  13. Langner S, Khaw AV, Fretwurst T, Angermaier A, Hosten N, Kirsch M. Endovascular treatment of acute ischemic stroke under conscious sedation compared to general anesthesia-safety, feasibility and clinical and radiological outcome. Rofo. 2013;185(4):320–7.

    Article  CAS  PubMed  Google Scholar 

  14. Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119(3):e21–181.

    Article  PubMed  Google Scholar 

  15. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367(9524):1747–57.

    Article  PubMed  Google Scholar 

  16. Lowhagen Henden P, Rentzos A, Karlsson JE, et al. Hypotension during endovascular treatment of ischemic stroke is a risk factor for poor neurological outcome. Stroke. 2015;46(9):2678–80.

    Article  PubMed  Google Scholar 

  17. ÖSSUR. https://www.ossur.com/injury-solutions/products/spine/pre-hospital-and-extrication-collars/patriot-collar. Accessed 16 July 2016.

  18. Saver JL. Time is brain–quantified. Stroke. 2006;37(1):263–6.

    Article  PubMed  Google Scholar 

  19. Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285–95.

    Article  CAS  PubMed  Google Scholar 

  20. Saver JL, Jahan R, Levy EI, et al. SOLITAIRE with the intention for thrombectomy (SWIFT) trial: design of a randomized, controlled, multicenter study comparing the SOLITAIRE Flow Restoration device and the MERCI Retriever in acute ischaemic stroke. Int J Stroke. 2014;9(5):658–68.

    Article  CAS  PubMed  Google Scholar 

  21. Soize S, Kadziolka K, Estrade L, Serre I, Bakchine S, Pierot L. Mechanical thrombectomy in acute stroke: prospective pilot trial of the solitaire FR device while under conscious sedation. AJNR Am J Neuroradiol. 2012;34(2):360–5.

    Article  PubMed  Google Scholar 

  22. Stampfl S, Hartmann M, Ringleb PA, Haehnel S, Bendszus M, Rohde S. Stent placement for flow restoration in acute ischemic stroke: a single-center experience with the solitaire stent system. AJNR Am J Neuroradiol. 2011;32(7):1245–8.

    Article  CAS  PubMed  Google Scholar 

  23. van den Berg LA, Koelman DL, Berkhemer OA, et al. Type of anesthesia and differences in clinical outcome after intra-arterial treatment for ischemic stroke. Stroke. 2015;46(5):1257–62.

    Article  PubMed  Google Scholar 

  24. Yoo AJ, Verduzco LA, Schaefer PW, Hirsch JA, Rabinov JD, Gonzalez RG. MRI-based selection for intra-arterial stroke therapy: value of pretreatment diffusion-weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early recanalization. Stroke. 2009;40(6):2046–54.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Zaidat OO, Yoo AJ, Khatri P, et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke. 2013;44(9):2650–63.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neuroradiology, Ludwig-Maximilians-University Hospital, Marchioninistr 15, 81377, Munich, Germany

    H. Janssen, L. Ertl & H. Brückmann

  2. Department of Neurology, Ludwig-Maximilians-University Hospital, Marchioninistr 15, 81377, Munich, Germany

    G. Buchholz

  3. Neurology/Research Institute of Neurointervention, Paracelsus Medical University, Ignaz Harrer Str. 79, 5020, Salzburg, Austria

    M. Killer

  4. Department of Neuroradiology, Ingolstadt Hospital, Krumenauerstraße 25, 85049, Ingolstadt, Germany

    J. Lutz

Authors
  1. H. Janssen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Buchholz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Killer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Ertl
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Brückmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Lutz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Janssen.

Ethics declarations

Conflict of interest

H. Janssen, G. Buchholz, L. Ertl , H. Brückmann, and J. Lutz declare that they have no conflict of interest. M. Killer received a research grant from MicroVention, Inc. and is consultant for Medtronic and MicroVention, Inc.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Janssen, H., Buchholz, G., Killer, M. et al. General Anesthesia Versus Conscious Sedation in Acute Stroke Treatment: The Importance of Head Immobilization. Cardiovasc Intervent Radiol 39, 1239–1244 (2016). https://doi.org/10.1007/s00270-016-1411-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-016-1411-5

Keywords

Search

Navigation