Endovascular therapy of isolated posterior cerebral artery occlusion stroke with and without general anesthesia
Authors: Berberich Anne , Herweh Christian , Qureshi Muhammad M , Strambo Davide , Michel Patrik , Räty Silja , Abdalkader Mohamad , Virtanen Pekka , Olive Gadea Marta , Ribo Marc , Psychogios Marios-Nikos , Nguyen Anh , Kuramatsu Joji B , Haupenthal David , Köhrmann Martin , Deuschl Cornelius , Kühne Escolà Jordi , Demeestere Jelle , Lemmens Robin , Yaghi Shadi , Shu Liqi , Kaiser Daniel P O , Puetz Volker , Kaesmacher Johannes , Mujanovic Adnan , Marterstock Dominique Cornelius , Engelhorn Tobias , Klein Piers , Haussen Diogo C , Mohammaden Mahmoud H , Cunha Bruno , Fragata Isabel , Romoli Michele , Hu Wei , Zhang Chao , Matsoukas Stavros , Fifi Johanna T , Sheth Sunil A , Salazar-Marioni Sergio , Marto João Pedro , Ramos João Nuno , Miszczuk Milena , Riegler Christoph , Poli Sven , Poli Khouloud , Jadhav Ashutosh P , Desai Shashvat M , Maus Volker , Kaeder Maximilian , Siddiqui Adnan H , Monteiro Andre , Peltola Erno , Masoud Hesham , Suryadareva Neil , Mokin Maxim , Thanki Shail , Alpay Kemal , Rautio Riitta , Siegler James E , Asdaghi Negar , Saini Vasu , Linfante Italo , Dabus Guilherme , Nolte Christian H , Siebert Eberhard , Möhlenbruch Markus A , Fischer Urs , Nogueira Raul G , Hanning Uta , Meyer Lukas , Ringleb Peter Arthur , Strbian Daniel , Nguyen Thanh N , Nagel Simon 
Published: June 2024

Background

The optimal anesthetic strategy for endovascular therapy (EVT) in acute ischemic stroke is still under debate. The aim of this study was to compare the clinical outcomes of patients with isolated posterior cerebral artery (PCA) occlusion stroke undergoing EVT by anesthesia modality with conscious sedation (non-GA) versus general anesthesia (GA).

Methods

Patients from the Posterior CerebraL Artery Occlusion (PLATO) study were analyzed with regard to anesthetic strategy. GA was compared with non-GA using multivariable logistic regression and inverse probability of weighting treatment (IPTW) methods. The primary endpoint was the 90-day distribution of the modified Rankin Scale (mRS) score. Secondary outcomes included functional independence or return to Rankin at day 90, and successful reperfusion, defined as expanded Thrombolysis in Cerebral Infarction (eTICI) 2b to 3. Safety endpoints were symptomatic intracranial hemorrhage and mortality.

Results

Among 376 patients with isolated PCA occlusion stroke treated with EVT, 183 (49%) had GA. The treatment groups were comparable, although the GA group contained more patients with severe stroke and lower posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS). On IPTW analysis, there was no difference between groups with regard to ordinal mRS shift analysis (common OR 0.89, 95% CI 0.53 to 1.51, P=0.67) or functional independence (OR 0.84, 95% CI 0.50 to 1.39, P=0.49). There were greater odds for successful reperfusion with GA (OR 1.70, 95% CI 1.17 to 2.47, P=0.01). Safety outcomes were comparable between groups.

Conclusion

In patients with isolated PCA occlusion undergoing EVT, patients treated with GA had higher reperfusion rates compared with non-GA. Both GA and non-GA strategies were safe and functional outcomes were similar.