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Is mechanical embolectomy performed in nonanesthetized patients effective?

R M Sugg1, A S Jackson, W Holloway

  • 1Saint Luke's Hospital, Kansas City, Missouri, USA. Rsugg@saint-lukes.org

AJNR. American Journal of Neuroradiology
|April 17, 2010
PubMed
Summary

Performing mechanical embolectomy on awake patients with acute ischemic stroke (AIS) is effective, with no increase in procedure time or complications. This approach offers comparable revascularization rates and potentially better outcomes compared to general anesthesia.

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Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Vascular Surgery

Background:

  • Variability exists in anesthesia use for endovascular treatment of acute ischemic stroke (AIS).
  • General anesthesia may delay procedures and obscure neurological assessments, while nonanesthetized patients risk movement and reduced cooperation.
  • This center does not routinely use general anesthesia or sedation for mechanical embolectomy.

Purpose of the Study:

  • To evaluate the safety and efficacy of performing emergent mechanical embolectomy in nonanesthetized patients with AIS.
  • To compare outcomes, procedural times, and complication rates between anesthetized and nonanesthetized patients.

Main Methods:

  • Retrospective analysis of 66 consecutive patients undergoing mechanical embolectomy (MERCI Registry).

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  • Comparison of demographics, procedural times, complications, and outcomes between general anesthesia and nonanesthetized groups.
  • Univariate statistical analysis using Fisher exact and Student t tests.

    • Main Results:

    • 86.4% of patients were treated awake; general anesthesia was associated with higher baseline NIHSS scores and older age.
    • No significant difference in time to groin puncture or procedural times between groups.
    • Complications were significantly more frequent in the general anesthesia group (22%) versus the nonanesthetized group (3.5%).

    Conclusions:

    • Mechanical embolectomy in nonanesthetized AIS patients is effective and safe.
    • This approach does not prolong procedure time, decrease revascularization rates, or increase complications.
    • Nonanesthetized mechanical embolectomy should be considered a viable treatment option for AIS.