Anaesthesia for mechanical thrombectomy: a narrative review

Area of Science:

• Neurology
• Interventional Neurology
• Critical Care Medicine

Background:

• Stroke is a major cause of death and disability, imposing a significant societal and economic burden.
• Mechanical thrombectomy is a key intervention for acute ischemic stroke caused by large vessel occlusion, requiring vessel recanalization.
• Factors influencing thrombectomy success include time to reperfusion, occlusion site, collateral flow, reperfusion quality, patient age, and stroke severity.

Purpose of the Study:

• To review the current understanding of mechanical thrombectomy for large vessel occlusion ischemic stroke.
• To discuss the controversial role of anesthetic technique (conscious sedation vs. general anesthesia) on patient outcomes.
• To emphasize the importance of periprocedural care, particularly blood pressure management, in optimizing outcomes.

Main Methods:

• Review of recent randomized controlled trials and published research on mechanical thrombectomy for ischemic stroke.
• Analysis of factors affecting thrombectomy efficacy.
• Discussion on the comparative outcomes of conscious sedation versus general anesthesia.

Main Results:

• Mechanical thrombectomy has proven efficacy in treating large vessel occlusion ischemic strokes, leading to global changes in stroke care.
• Conflicting results exist regarding the optimal anesthetic technique, though recent trials suggest general anesthesia may be equivalent or superior to conscious sedation.
• Optimal blood pressure management is identified as a critical determinant of patient outcome.

Conclusions:

• Mechanical thrombectomy is a vital treatment for large vessel occlusion ischemic stroke.
• Anesthetic management should be individualized, with emerging evidence favoring general anesthesia in some contexts.
• High-quality periprocedural care, focusing on minimizing delays and maintaining adequate blood pressure, is essential for improving patient outcomes in acute ischemic stroke.