General Anesthesia During Endovascular Stroke Therapy Does Not Negatively Impact Outcome

Area of Science:

• Neurology
• Interventional Neurology
• Vascular Neurology

Background:

• Endovascular therapy improves outcomes for acute ischemic stroke with large vessel occlusion.
• Subgroup analyses suggest general anesthesia (GA) may be associated with worse outcomes compared to non-general anesthesia (non-GA).
• Current guidelines recommend considering non-GA, but lack specific trial data.

Purpose of the Study:

• To review outcomes of mechanical thrombectomy for acute ischemic stroke performed under routine general anesthesia (GA).
• To compare these outcomes with historical data from the MR CLEAN trial, analyzing both GA and non-GA subgroups.

Main Methods:

• Retrospective analysis of 60 patients with anterior circulation strokes receiving IV-tPA and endovascular therapy.
• Collected data included NIHSS and modified Rankin Scale scores.
• Outcomes were compared to historical data from the MR CLEAN trial.

Main Results:

• Successful recanalization (TICI 2b-3) was achieved in 76.4% of patients.
• At discharge, mortality was 16.7%, median NIHSS was 5, and 38.3% had a modified Rankin Scale score of 0-2.
• Despite a median onset to treatment time of 265 minutes, outcomes compared favorably to MR CLEAN subgroups.

Conclusions:

• Routine general anesthesia (GA) does not appear to worsen outcomes in mechanical thrombectomy for acute ischemic stroke.
• Outcomes in this GA cohort were favorable when compared to historical GA and non-GA groups from the MR CLEAN trial.