Introduction: The use of conscious sedation versus general anesthesia (GA) for mechanical thrombectomy for acute ischemic stroke has been reviewed in sub-group analysis in the large randomized stroke trials. Some of the data suggests patients who undergo stroke intervention without GA may have improved outcomes. The Trevo Registry is a real-world registry designed to assess real world outcomes of the Trevo Retriever in patients experiencing acute ischemic stroke. This is the largest prospective study for acute stroke intervention that has currently enrolled 1431 patients with 90-day outcomes data. Anesthetic usage was evaluated in this registry.
Methods: The study design is a prospective, open-label, consecutive enrollment, multi-center, international registry of all patients who undergo mechanical thrombectomy for acute stroke using the Trevo stent retriever as the initial device. Enrollment is expected to reach 2000 subjects at up to 100 sites. Outcome data was reviewed for those patients with 90-day outcome data regarding the use of GA versus conscious sedation.
Results: As of March 25, 2017, a total of 1846 patients were enrolled. The median NIHSS at admission was 15.5 (IQR 11-20). GA was employed in 45.1% of procedures. There was no significant difference in patient characteristics between the two groups. Significantly more patients in the GA group were found to have posterior circulation occlusion. Sixty-one of 572 (10.7%) were found to have vertebrobasilar large artery occlusion in the general anesthesia group versus 28/695 (4.0%) in the conscious sedation group. There was no significant difference in baseline NIHSS. There was no significant difference in 90-day outcomes or morbidity.
Conclusions: The Trevo Retriever Registry represents the first look at real world data with stent retriever use in the era of clinical trials showing the overwhelming benefit of stent retrievers to treat acute ischemic stroke. In real-world use, GA was more commonly used in posterior circulation strokes and was not associated with worse outcomes.
Patient Care: by understanding true real-world trends in anesthesia during stroke intervention and 90-day outcomes
Learning Objectives: That in real world use, general anesthesia is more commonly used for intervention for posterior circulation strokes and outcomes are not worse