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CardioVascular and Interventional Radiology

, Volume 39, Issue 9, pp 1239–1244 | Cite as

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

  • H. JanssenEmail author
  • G. Buchholz
  • M. Killer
  • L. Ertl
  • H. Brückmann
  • J. Lutz
Clinical Investigation

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.

Keywords

Stroke Anesthesia Thrombectomy 

Notes

Compliance with Ethical Standards

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.

References

  1. 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.CrossRefPubMedGoogle Scholar
  2. 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.CrossRefPubMedGoogle Scholar
  3. 3.
    Brekenfeld C, Mattle HP, Schroth G. General is better than local anesthesia during endovascular procedures. Stroke. 2010;41(11):2716–7.CrossRefPubMedGoogle Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. 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.CrossRefPubMedGoogle Scholar
  6. 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.CrossRefPubMedGoogle Scholar
  7. 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.CrossRefPubMedGoogle Scholar
  8. 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.CrossRefPubMedGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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.CrossRefPubMedGoogle Scholar
  14. 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.CrossRefPubMedGoogle Scholar
  15. 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.CrossRefPubMedGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 17.
  18. 18.
    Saver JL. Time is brain–quantified. Stroke. 2006;37(1):263–6.CrossRefPubMedGoogle Scholar
  19. 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.CrossRefPubMedGoogle Scholar
  20. 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.CrossRefPubMedGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 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.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2016

Authors and Affiliations

  • H. Janssen
    • 1
    Email author
  • G. Buchholz
    • 2
  • M. Killer
    • 3
  • L. Ertl
    • 1
  • H. Brückmann
    • 1
  • J. Lutz
    • 4
  1. 1.Department of NeuroradiologyLudwig-Maximilians-University HospitalMunichGermany
  2. 2.Department of NeurologyLudwig-Maximilians-University HospitalMunichGermany
  3. 3.Neurology/Research Institute of NeurointerventionParacelsus Medical UniversitySalzburgAustria
  4. 4.Department of NeuroradiologyIngolstadt HospitalIngolstadtGermany

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