Local Anesthesia Without Sedation During Thrombectomy for Anterior Circulation Stroke Is Associated With Worse Outcome
Authors: Benvegnù Francesco , Richard Sébastien , Marnat Gaultier , Bourcier Romain , Labreuche Julien , Anadani Mohammad , Sibon Igor , Dargazanli Cyril , Arquizan Caroline , Anxionnat René , Audibert Gérard , Zhu François , Mazighi Mikaël , Blanc Raphaël , Lapergue Bertrand , Consoli Arturo , Gory Benjamin , Piotin Michel , Redjem Hocine , Escalard Simon , Desilles Jean-Philippe , Ciccio Gabriele , Smajda Stanislas , Obadia Mikael , Sabben Candice , Corabianu Ovide , de Broucker Thomas , Smadja Didier , Alamowitch Sonia , Ille Olivier , Manchon Eric , Garcia Pierre-Yves , Taylor Guillaume , Maacha Malek Ben , Wang Adrien , Evrard Serge , Tchikviladze Maya , Ajili Nadia , Weisenburger David , Gorza Lucas , Coskun Oguzhan , Di Maria Federico , Rodesh Georges , Leguen Morgan , Gratieux Julie , Pico Fernando , Rakotoharinandrasana Haja , Tassan Philippe , Poll Roxanna , Marinier Sylvie , Gariel Florent , Barreau Xavier , Berge Jérôme , Veunac Louis , Menegon Patrice , Lucas Ludovic , Olindo Stéphane , Renou Pauline , Sagnier Sharmila , Poli Mathilde , Debruxelles Sabrina , Tourdias Thomas , Liegey Jean-Sebastien , Detraz Lili , Daumas-Duport Benjamin , Alexandre Pierre-Louis , Roy Monica , Lenoble Cédric , L’allinec Vincent , Girot Jean-Baptiste , Desal Hubert , Costa Isabelle , Bracard Serge , Braun Marc , Derelle Anne-Laure , Tonnelet Romain , Liao Liang , Schmitt Emmanuelle , Planel Sophie , Humbertjean Lisa , Mione Gioia , Lacour Jean-Christophe , Riou-Comte Nolwenn , Hossu Gabriela , Beaumont Marine , Bailang Mitchelle , Reitter Marie , Masson Agnès , Alb Lionel , Tabarna Adriana , Voicu Marcela , Podar Iona , Brezeanu Madalina , Costalat Vincent , Gascou Grégory , Lefèvre Pierre-Henri , Derraz Imad , Riquelme Carlos , Gaillard Nicolas , Mourand Isabelle , Corti Lucas 
Published: September 2020

Background and Purpose:
The best anesthetic management for mechanical thrombectomy of large vessel occlusion strokes is still uncertain and could impact the quality of reperfusion and clinical outcome. We aimed to compare the efficacy and safety outcomes between local anesthesia (LA) and conscious sedation in a large cohort of acute ischemic stroke patients with anterior circulation large vessel occlusion strokes treated with mechanical thrombectomy in current, everyday clinical practice.

Methods:
Patients undergoing mechanical thrombectomy for anterior large vessel occlusion strokes at 4 comprehensive stroke centers in France between January 1, 2018, and December 31, 2018, were pooled from the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France. Intention-to-treat and per-protocol analyses were used.

Results:
Among the included 1034 patients, 762 were included in the conscious sedation group and 272 were included in the LA group. In the propensity score matched cohort, the rate of favorable outcome (90-day modified Rankin Scale score 0–2) was significantly lower in the LA group than in the conscious sedation group (40.0% versus 52.0%, matched relative risk=0.76 [95% CI, 0.60–0.97]), as well as the rate of successful reperfusion (modified Thrombolysis in Cerebral Infarction grade 2b–3; 76.6% versus 87.1%; matched relative risk=0.88 [95% CI, 0.79–0.98]). There was no difference in procedure time between the 2 groups. In the inverse probability of treatment weighting-propensity score-adjusted cohort, similar significant differences were found for favorable outcomes and successful reperfusion. In inverse probability of treatment weighting-propensity score-adjusted cohort, a higher rate of 90-day mortality and a lower parenchymal hematoma were observed after LA. The sensitivity analysis restricted to our per-protocol sample provided similar results in the matched- and inverse probability of treatment weighting-propensity cohorts.

Conclusions:
In the Endovascular Treatment in Ischemic Stroke registry mainly included patients in early time window (<6 hours), LA was associated with lower odds of favorable outcome, successful reperfusion, and higher odds of mortality compared with conscious sedation for mechanical thrombectomy of large vessel occlusion.