The impact of general anesthesia versus non–general anesthesia on thrombectomy outcomes by occlusion location: insights from the ETIS registry
Authors: Anadani Mohammad , Gory Benjamin , Olivot Jean-Marc , Bourcier Romain , Consoli Arturo , Boulouis Grégoire , Janot Kevin , Pop Raoul , Desilles Jean-Philippe , Hamoud Lina , Mazighi Mikael , Lapergue Bertrand , Marnat Gaultier , Finitsis Stefanos , _ _ , Lapergue Bertrand , Wang Adrien , Consoli Arturo , Coskun Oguzhan , Maria Federico Di , Pizzuto Silvia , Sgreccia Alessandro , Benoit Charline , Gorza Lucas , Weisenburger-Lile David , Jabeur Waliyde , Maia Tchikviladze , Evrard Serge , Rodesch Georges , Blanc Raphaël , Obadia Michel , Desilles Jean-Philippe , Piotin Michel , Seners Pierre , Smajda Stanislas , Escalard Simon , Maier Benjamin , Sabben Candice , Redjem Hocine , Mazhigi Mikael , Adwane Grace , Delvoye François , isseau Amira Al Raaisi , Adnan Altayeb , Thomas Malayer , Erwan Robichon , Bourcier Romain , Duport Benjamin Daumas , Alexandre Pierre Louis , Lenoble Cédric , Desal Hubert , De Gaalon Solene , Guillon Benoît , Preterre Cécile , Tessier Guillaume , Lionnet Arthur , Gory Benjamin , Humbertjean-Selton Lisa , Anxionnat René , Derelle Anne-Laure , Liao Liang , Schmitt Emmanuelle , Planel Sophie , Richard Sébastien , Mione Gioia , Lacour Jean-Christophe , Douarinou Marian , Micard Emilien , Chen Bailiang , Audibert Gérard , Masson Agnès , Alb Lionel , Beaumont Marine , Tabarna Adriana , Voicu Marcela , Barthel Grégoire , Podar Iona , Brezeanu Madalina , Reitter Marie , Zhu François , René Anxionnat , Marnat Gaultier , Liegey Jean-Sébastien , Briau Pierre , Papillon Lisa , Sibon Igor , Barreau Xavier , Papaxanthos Jean , Berge Jérome , Debruxelles Sabrina , Olindo Stéphane , Poli Mathilde , Renou Pauline , Sagnier Sharmila , Tourdias Thomas , Courret Thomas , Lucas Ludovic , Milnerowicz Malgorzata , Dargazanli Cyril , Costalat Vincent , Mourand Isabelle , Arquizan Caroline , Corti Lucas , Schiphorst Adrien Ter , Federico Cagnazzo , Derraz Imad , Mahmoudi Mehdi , Lefevre Pierre-Henri , Gascou Grégory , Varnier Quentin , Spelle Laurent , Caroff Jildaz , Denier Christian , Chalumeau Vanessa , Mihalea Cristian , Legris Nicolas , Ozanne Augustin , Ikka Leon , Chassin Olivier , Gallas Sophie , Venditti Laura , Sarov Mariana , Cortese Jonathan , Ferre Jean-Christophe , Vannier Stephane , Ronziere Thomas , Lassalle Maria Veronica , Gauvrit Jean-Yves , Tracol Clement , Boustia Abdelghani Fakhreddine , Malrain Cecile , Beaufreton Edouard , Lapotre Thibault , Alias Quentin , Hissier Julien , Guillen Maud , Eugene François , Julien Boucherit , Chivot Cyril , Courselle Audrey , Ouin Elisa , Lamy Chantal , Delaforge Kevin , Fernandez Manuel , Vial Jeremie , Laferte Quentin , Desdoit Xavier , Timsit Serge , Jourdain Aurore , Gentric Jean-Christophe , Ognard Julien , Viakhireva Irina , Coris Jordan , Prud’hon Sabine , Merrien François-Mathias , Marechal Denis , Bruguet Marie , Rousseau Pierre Yves , Goas Philippe , Retho Elise , Lavenant Caroline , Gal Rozenn Le , Amelie Leblanc , Boulanger Marion , Touze Emmanuel , Vivien Denis , Barbier Charlotte , Schneckenburger Romain , Salaris Fabrizio , Cogez Julien , Guettier Sophie , Porte Estelle La , Bouchart Jean , Mounayer Charbel , Rouchaud Aymeric , Saleme Suzana , Forestier Géraud , Clarencon Frédéric , Rosso Charlotte , Leder Sara , Baronnet Flore , Crozier Sophie , Leger Anne , Premat Kevin , Eimad Shotar , Lenck Stéphanie , Sourour Nader , Bottin Laure , Ghazanfari Sam , Yger Marion , Alamowitch Sonia , Delorme Stephen , Wittwer Aymeric , Vassilev Christine , Julien Allard , Naggara Olivier , Turc Guillaume , Hassen Wagih Ben , Kerleroux Basile , Trystram Denis , Rodriguez-Regent Christine , Laza-Nomenjanahary Finoana , Ozkul-Wermester Ozlem , Papagiannaki Chrysanthi , Massardier Evelyne , Triquenot Aude , Lefebvre Margaux , Burel Julien , Florient Basille , Viguier Alain , Cognard Christophe , Januel Anne Christine , Albucher Jean-François , Calviere Lionel , Olivot Jean-Marc , Darcourt Jean , Raposo Nicolas , Bonneville Fabrice , Bellanger Guillaume , Fontaine Louis , Tall Philippe , Bourdain Frédéric , Bernady Patricia , Ballan Guillaume , Bannier Stephanie , Ellie Emmanuel , Flabeau Olivier , Potenza Julia , Soulages Antoine , Lagoarde-Segot Laurent , Cailliez Hélène , Veunac Louis , Higue David , Lebras Anthony , Adam Sarah , Pegat Benoit , Guen Arnaud Le , Chedeville François , Jouan Jérémy , Rémi Allibert , Courtois Alexanre , Evain Sarah , Lucile Lescot , Demasles Stéphanie , Richter Johann Sebastian , Barroso Bruno Thierry , Dahan Camille , Gonnet Alexis , Hubrecht Régis , Lepine Zoé , Castagnet Hélène , Marasescu Raluca , Heck Olivier , Cuisenier Pauline , Detante Olivier , Wiki Isabelle Favre , Bonaz Clémentine , Katia Garambois , Legris Loic , Kastler Adrian , Boubagra Kamel , Berthet Corentin , Charara Stéphane , Dumas Victor , Philippe Neau Jean , Stéphane Velasco , Wolff Valérie , Pop Raoul , Quenardelle Véronique , Lauer Valérie , Pierre-Paul Irène , Gheoca Roxana , Trzeciak Malwina , Daniella Bindila Perisse , Camille Bonnart , Moulin Solène , Tuan Hua Vi , Pagano Paolo , Doucet Alexandre , Gelmini Christophe , Manceau Pierre-François , Pajusan Laurentiu , Serre Isabelle , Soize Sébastien , Nguyen Thi Ngoc Phuong , Sahnoun Maher , Caucheteux Nathalie , Lebindsky Pablo , Vanessa Nader , Bolignini Federico , Vuillemet Francis , Rodregues José , Ferrier Anna , Zerroug Abderrahim , Moreno Ricardo , Chabert Emmanuel , Lteif Elie , Paris Pauline , Bourgois Nathalie , Raquin Marie , Pasco-Papon Anne , Girot Jean Baptiste , Lecluse Alderic , Godard Sophie , L’Allinec Vincent , Alice Corfu , Janot Kevin , Bibi Richard , Gaudron Marie , Bretonniere Arnaud , Annan Mariam , Ifergan Héloïse , Boulouis Grégoire , Pasi Marco , Debiais Séverine , Molinier Elisabeth , Herbretau Denis , Doung Romain , Bala Fouzi , Hoche Clemencie , Wietrich Anthony , Ruche Valérie , Lavandier Karine , Bejot Yannick , Lemogne Brivale , Ricolfi Fédéric , Baptiste Laura , Thouant Pierre , Duloquin Gaulthier , Comby Pierre Olivier , Charbonnier Guillaume , Bonnet Louise , Raybaud Nicolas , Bouamra Benjamin , Moulin Thierry , Biondi Alessandra , Fernando Pico , Benjamin Dano , Carmen Patcas , Dhouha Chaari , Daniela Stanciu , Long Duang Duc , Intissar Hmida , Chadenat Marie-Laure , Laurent Suissa , Emilie Doche , Jean-François Hak , Anthony Reyre , Xavier Carle , Nadia Laksiri , Ophélie Osman , Roxane Peres , Emmanuelle Robinet-Borgomano , Cécile Dulau , Basile Kerleroux , Caroline Rey , Berge Jérôme , Bing Fabrice 
Published: August 2024

OBJECTIVE
Identifying the optimal anesthetic technique for mechanical thrombectomy (MT) remains an unresolved issue. Prior research has not considered the influence of occlusion site when comparing general anesthesia (GA) with non-GA. This study evaluates the differential impacts of the anesthetic technique (GA vs non-GA) on outcomes according to the location of occlusion.

METHODS
This is a retrospective analysis of the ETIS (Endovascular Treatment in Ischemic Stroke) registry. Patients with anterior circulation large-vessel occlusion treated with MT were included. Patients were divided into groups according to the location of occlusion. Inverse propensity score weighting analysis was used.

RESULTS
Among 2783 patients included in the propensity score analysis, 669 (24%) received GA. In the total cohort, GA was not associated with favorable outcome, excellent outcome, successful reperfusion, or complete reperfusion. GA was associated with higher odds of parenchymal hemorrhage (OR 1.42, 95% 1.05–1.92) but not symptomatic intracranial hemorrhage. GA was associated with Alberta Stroke Program Early CT Score progression (OR 1.36, 95% CI 1.11–1.68). In the internal carotid artery occlusion group, GA was associated with higher odds of mortality (OR 1.94, 95% CI 1.15–3.27). In the M1 group, GA was associated with lower odds of complications (OR 0.41, 95% CI 0.19–0.92). In the M2 group, GA was associated with successful reperfusion (OR 2.79, 95% CI 1.02–7.64). In addition, the complication rate was lower with GA (2.7% vs 7%), although the association was not significant in adjusted analysis.

CONCLUSIONS
While GA and non-GA techniques did not differ significantly in functional outcomes, the influence of GA on angiographic and procedural safety outcomes was location dependent, underscoring the importance of a tailored anesthesia technique in MT procedures.