Procedural efficiency and technical success with general anesthesia vs. conscious sedation in mechanical thrombectomy

The optimal anesthetic approach for thrombectomy remains unclear. This study examined how anesthesia type influences efficiency and angiographic outcomes after adjustment for stroke severity, occlusion site, and key procedural factors.

Registry data from 2019-2025 were analyzed by anesthesia type to compare baseline characteristics, workflow metrics, and outcomes. Successful reperfusion (final TICI ≥2B) and first-pass effect (TICI 3 in one pass) were assessed. Multivariable logistic regression evaluated whether anesthesia type independently predicted successful reperfusion after adjusting for admission NIHSS score > 15, occlusion site, intravenous thrombolysis, number of passes, and procedure duration.

Among 1070 patients, 74% underwent thrombectomy under general anesthesia (GA) and 26% under conscious sedation (CS). Patients treated with GA presented with higher stroke severity (NIHSS > 15, 64.6% vs 42.0%; p < 0.0001), more posterior circulation occlusions (9.3% vs 4.0%; p = 0.006), and less intravenous thrombolysis (24.3% vs 37.0%; p < 0.0001). Workflow times were similar between groups. GA was associated with a higher rate of successful reperfusion (94.1% vs 87.7%; p = 0.0005) despite slightly more device passes. After adjustment, GA remained was associated with higher odds of successful reperfusion (adjusted odds ratio [GA vs CS], 3.23; 95% CI, 1.72-6.09; p = 0.0003), whereas first-pass effect did not differ (adjusted odds ratio [GA vs CS], 0.82; 95% CI, 0.39-1.69; p = 0.59).

GA was used in more complex, severe cases but was associated with higher reperfusion without delaying workflow. Anesthetic selection should prioritize airway protection, physiological stability, and procedural control.