Ideal sedation for stroke thrombectomy: a prospective pilot single-center observational study

Area of Science:

• Neurology
• Interventional Radiology
• Anesthesiology

Background:

• Retrospective studies favored conscious sedation (CS) over general anesthesia (GA) for stroke thrombectomy.
• A recent trial found no outcome difference between CS and GA.

Purpose of the Study:

• To compare time and outcomes for anterior circulation ischemic stroke reperfusion using GA versus monitored anesthesia care (MAC).
• To evaluate the Ideal Sedation for Stroke Thrombectomy (ISST) study's findings.

Main Methods:

• Prospective, open-label registry study (ISST).
• 40 patients with anterior circulation ischemic stroke undergoing mechanical thrombectomy.
• Primary endpoint: time from interventional radiology arrival to reperfusion.

Main Results:

• MAC group (32 patients) had a 2x shorter reperfusion time than the GA group (8 patients).
• Complete reperfusion (TICI grade 3) exceeded 50% in both groups.
• Mean 3-month modified Rankin Scale score was <2 for MAC vs. >3 for GA (p=0.021).

Conclusions:

• MAC demonstrated a significantly shorter reperfusion interval compared to GA.
• MAC was associated with better patient outcomes at 3 months post-stroke reperfusion.
• This pilot study supports MAC as a preferred sedation method for anterior circulation stroke thrombectomy.