General Anesthesia Versus Non-General Anesthesia in Young Adults Undergoing Thrombectomy

Area of Science:

• Neurology
• Anesthesiology
• Interventional Cardiology

Background:

• Endovascular thrombectomy (EVT) is standard care for anterior circulation large vessel occlusion (LVO).
• The optimal anesthetic strategy for EVT in young adults (18-50 years) with LVO is not well-defined.
• This study addresses the anesthetic choice in a specific, younger demographic undergoing a critical stroke intervention.

Purpose of the Study:

• To compare the effectiveness of general anesthesia (GA) versus non-general anesthesia (non-GA) in young adults undergoing EVT for LVO.
• To evaluate the impact of anesthetic strategy on functional independence and other key outcomes post-EVT.
• To provide evidence to guide anesthetic selection for this patient population.

Main Methods:

• A pooled analysis of individual patient data from three trials (DEVT, RESCUE BT, MARVEL) was conducted using target trial emulation.
• Patients aged 18-50 years undergoing EVT for LVO were analyzed, comparing GA to non-GA (conscious sedation/local anesthesia).
• Outcomes were assessed using inverse probability of treatment weighting (IPTW) and G-computation, focusing on 90-day functional independence (mRS 0-2).

Main Results:

• Non-GA was associated with significantly higher rates of 90-day functional independence compared to GA (RD 0.12).
• General anesthesia (GA) was linked to increased incidence of pneumonia (RD -0.21).
• No significant differences were observed between GA and non-GA in reperfusion success, mortality, or symptomatic intracranial hemorrhage (sICH).

Conclusions:

• In young adults with anterior circulation LVO undergoing EVT, non-GA is associated with better functional independence outcomes compared to GA.
• Anesthetic strategy did not significantly impact reperfusion success or sICH rates.
• These findings support considering non-GA for young stroke patients undergoing EVT, pending further randomized trials.