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Thrombectomy with Conscious Sedation Compared with General Anesthesia: A DEFUSE 3 Analysis
C J Powers1, D Dornbos2, M Mlynash3
1From the Departments of Neurological Surgery (C.J.P., D.D., S.M.N.) ciaran.powers@osumc.edu.
AJNR. American Journal of Neuroradiology
|May 11, 2019
Summary
Conscious sedation during mechanical thrombectomy for ischemic stroke in the extended time window improved patient outcomes. Patients receiving conscious sedation had better functional independence and faster reperfusion times compared to general anesthesia.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Optimal patient sedation for mechanical thrombectomy in extended time window ischemic stroke remains unclear.
- Mechanical thrombectomy is a critical intervention for acute ischemic stroke.
Purpose of the Study:
- To evaluate the impact of patient sedation on outcomes in mechanical thrombectomy for ischemic stroke.
- To compare functional independence and procedural times between general anesthesia and conscious sedation.
Main Methods:
- Analysis of data from the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 (DEFUSE 3) trial.
- Comparison of outcomes for patients undergoing thrombectomy with general anesthesia versus conscious sedation (6-16 hours from stroke onset).
Main Results:
- Conscious sedation was associated with significantly higher functional independence at 90 days (53% vs 23%).
- Conscious sedation led to shorter times to femoral puncture and reperfusion.
- These benefits were consistent in institutions using a single anesthesia technique.
Conclusions:
- Conscious sedation is linked to improved functional independence and procedural efficiency in extended time window thrombectomy.
- Conscious sedation may be a preferred sedation strategy for select ischemic stroke patients undergoing mechanical thrombectomy.
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