General Anesthesia Versus Conscious Sedation in Acute Stroke Treatment: The Importance of Head Immobilization
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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).
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.
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.
Mechanical thrombectomy can be performed faster and safely under CS in combination with simple head immobilization using a standard cervical collar.
KeywordsStroke Anesthesia Thrombectomy
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.
- 17.ÖSSUR. https://www.ossur.com/injury-solutions/products/spine/pre-hospital-and-extrication-collars/patriot-collar. Accessed 16 July 2016.
- 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
- 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