General Anesthesia versus Conscious Sedation in Mechanical Thrombectomy

Area of Science:

• Neurology
• Anesthesiology
• Interventional Radiology

Background:

• The optimal anesthesia regimen for mechanical thrombectomy (MT) remains an area of active investigation.
• Choosing the right anesthesia impacts patient outcomes and procedural efficiency.

Purpose of the Study:

• To compare the effects of different anesthesia regimens on outcomes in patients undergoing MT.
• To evaluate complication rates, procedural times, and functional outcomes associated with general anesthesia (GA) versus conscious sedation (CS).

Main Methods:

• Retrospective analysis of 6,635 patients from the German Stroke Registry-Endovascular Treatment (GSR-ET) between June 2015 and December 2019.
• Outcomes assessed included successful reperfusion, periprocedural complications, time intervals (admission to groin, groin to flow restoration), functional outcome (modified Rankin Scale), and mortality.
• Multivariable analysis was used to adjust for potential confounders.

Main Results:

• Conscious sedation (CS) was associated with a lower rate of periprocedural complications (15.0%) compared to general anesthesia (GA) (21.0%) and CS to GA conversion (28.3%).
• CS led to a higher rate of good functional outcome (mRS 0-2) at follow-up (42.1%) and a lower mortality rate (23.4%) compared to GA (34.2%) and CS to GA conversion (26.0%).
• GA was associated with a delay in admission to groin time (71.0 minutes) but comparable groin to flow restoration times.

Conclusions:

• Conscious sedation (CS) demonstrates significant advantages over general anesthesia (GA) for mechanical thrombectomy (MT).
• CS is associated with reduced complications, improved functional outcomes, and lower mortality rates in MT patients.
• These findings support CS as a potentially superior anesthesia choice for MT procedures.