General Anesthesia Versus Conscious Sedation and Local Anesthesia During Thrombectomy for Acute Ischemic Stroke
Authors: Cappellari Manuel , Pracucci Giovanni , Forlivesi Stefano , Saia Valentina , Nappini Sergio , Nencini Patrizia , Inzitari Domenico , Greco Laura , Sallustio Fabrizio , Vallone Stefano , Bigliardi Guido , Zini Andrea , Pitrone Antonio , Grillo Francesco , Musolino Rosa , Bracco Sandra , Tinturini Rebecca , Tassi Rossana , Bergui Mauro , Cerrato Paolo , Saletti Andrea , De Vito Alessandro , Casetta Ilaria , Gasparotti Roberto , Magoni Mauro , Castellan Lucio , Malfatto Laura , Menozzi Roberto , Scoditti Umberto , Causin Francesco , Baracchini Claudio , Puglielli Edoardo , Casalena Alfonsina , Ruggiero Maria , Malatesta Emanuele , Comelli Chiara , Chianale Gigliola , Lauretti Dario Luca , Mancuso Michelangelo , Lafe Elvis , Cavallini Anna , Cavasin Nicola , Critelli Adriana , Ciceri Elisa Francesca Maria , Bonetti Bruno , Chiumarulo Luigi , Petruzzelli Marco , Giorgianni Andrea , Versino Maurizio , Ganimede Maria Porzia , Tinelli Angelica , Auteri Wiliam , Petrone Alfredo , Guidetti Giulio , Nicolini Ettore , Allegretti Luca , Tassinari Tiziana , Filauri Pietro , Sacco Simona , Pavia Marco , Invernizzi Paolo , Nuzzi Nunzio Paolo , Carmela Spinelli Maria , Amistà Pietro , Russo Monia , Ferrandi Delfina , Corraine Simona , Craparo Giuseppe , Mannino Marina , Simonetti Luigi , Toni Danilo , Mangiafico Salvatore 
Published: June 2020

Background and Purpose:
As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA).

Methods:
We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke.

Results:
GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0–1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602–1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515–0.990). The rates of modified Rankin Scale score of 0–2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689–1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566–0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644–1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844–1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262–0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337–0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of <1, antiplatelet, and anticoagulant), differences were found also between GA versus CS as regards modified Rankin Scale score of 0–2 (aOR, 0.659 [95% CI, 0.538–0.807]) and GA versus LA as regards death (aOR, 1.413 [95% CI, 1.095–1.823]).

Conclusions:
GA during thrombectomy was associated with worse 3-month functional outcomes, especially when compared with LA. The inclusion of an LA arm in future randomized clinical trials of anesthesia strategy is recommended.