Impact of general anesthesia on posterior circulation large vessel occlusions after endovascular thrombectomy

Area of Science:

• Neurology
• Interventional Neuroradiology
• Anesthesiology

Background:

• The impact of general anesthesia on functional outcomes in patients with large vessel occlusion (LVO) is not fully understood.
• Research has primarily focused on anterior circulation LVO, leaving a knowledge gap regarding posterior circulation LVO under general anesthesia.

Purpose of the Study:

• To investigate the association between general anesthesia and clinical outcomes in patients with posterior circulation large vessel occlusion undergoing endovascular therapy.

Main Methods:

• A retrospective analysis of the prospective CICAT registry included 298 patients with posterior circulation LVO treated endovascularly between January 2016 and January 2020.
• Data collected included demographics, baseline characteristics, procedural details, and anesthesia type (general anesthesia vs. conscious sedation).
• The primary outcome was the proportion of patients achieving a good clinical outcome (modified Rankin Scale score 0-2) at three months.

Main Results:

• General anesthesia, along with factors like age, diabetes, renal insufficiency, higher NIHSS score, longer puncture-to-recanalization time, multiple device passes, and failed recanalization, were associated with poor outcomes (mRS 3-6).
• Multivariable regression identified general anesthesia (aOR: 3.11) and ≥3 device passes (aOR: 3.77) as independent predictors of poor outcome.
• Patients receiving general anesthesia had significantly lower rates of good outcomes at three months (19.7%) compared to those under conscious sedation (45.1%) (P < 0.001).

Conclusions:

• General anesthesia is associated with poor clinical outcomes in patients with posterior circulation large vessel occlusion undergoing endovascular treatment.
• Conscious sedation may be a preferable anesthesia strategy for improving functional recovery in this patient group.