General anesthesia vs local anesthesia during mechanical thrombectomy in acute ischemic stroke

Area of Science:

• Neurology
• Interventional Cardiology
• Anesthesiology

Background:

• Mechanical thrombectomy (MT) is a key treatment for acute ischemic stroke (AIS).
• Anesthesia choice, general anesthesia (GA) versus local anesthesia (LA), may impact outcomes.
• Limited data exists comparing GA and LA in AIS patients undergoing MT.

Purpose of the Study:

• To compare functional outcomes and complication rates in AIS patients treated with MT under GA versus LA.
• To evaluate the impact of GA on modified Rankin Scale (mRS) scores at 90 days and long-term follow-up.
• To determine if GA is associated with increased risks or poorer outcomes in AIS MT.

Main Methods:

• Observational study using a prospectively registered cohort of AIS patients undergoing MT.
• Patients treated with either GA or LA between January 2013 and October 2017 were included.
• Primary outcome: mRS score at 90 days. Secondary outcomes: functional independence, disability, mortality, complications, and serious adverse events. Multivariable logistic regression adjusted for confounders.

Main Results:

• 187 AIS patients were analyzed; GA group showed similar 90-day mRS scores to the LA group (median 2 vs 2.5).
• No significant differences in functional independence, minimal disability, or mortality rates were observed between GA and LA groups at 90 days or long-term.
• Procedure-related complications and serious adverse events were comparable between the two anesthesia groups (P > .05). Multivariable analysis confirmed GA was not associated with functional outcomes.

Conclusions:

• General anesthesia (GA) in AIS patients undergoing mechanical thrombectomy (MT) yields comparable functional outcomes to local anesthesia (LA).
• Complication rates and serious adverse events were similar between GA and LA groups.
• GA represents a safe anesthetic option for AIS patients undergoing MT, without compromising clinical outcomes.