Introduction: The use of general anesthesia (GA) for stroke patients undergoing endovacular acute ischemic stroke treatment is controversial. Subanalyses of the MR Clean trial showed no effect on functional outcome (MRS 0-2 at 90 days) in those who received GA. Critics of GA state it delays treatment initiation and limits the ability to perform a neurologic assessment during the procedure. At Duke, our IA-thrombectomy cases have received GA to date. We hypothesize that the benefits of GA allows us to perform a safer and more effective catheterization.
Methods: We performed a retrospective review of all patients receiving IA-thrombectomy patients from January 2015 to October 2015. Data include demographics, timing, safety, and good functional outcome (90 day MRS 0-2). Comparative analyses were performed between our data and the MR Clean subanalysis of GA vs. non-GA cohorts.
Results: 59 patients received endovascular treatment for ischemic stroke from January 2015 to October 2015. Demographic and baseline stroke characteristics were similar to those patients in the MR Clean trial. Our door to groin stick time was almost half that reported in the MR Clean trial GA cohort (78 minutes vs. 162 minutes). Good functional outcome at 90 days (MRS 0-2) was achieved by 33% of our patients, which is was more similar to the non-GA cohort (38%) than the GA cohort (23%) in the MR Clean trial. We had no deaths <7 days or vessel perforations (compared to 13% and 1.7%, respectively in non-GA cohort in the MR Clean trial).
Conclusions: GA for endovascular acute stroke treatment did not delay the initiation of treament or compromise good functional outcomes. Given the limitations of this comparative study, more prospective research needs to be performed to see the benefits of GA for endovascular acute ischemic stroke treatment.
Patient Care: This study supports the use of general anesthesia for IA-thrombectomy for ischemic strokes - a controversial issue. Most studies show that GA may delay reperfusion time and and a sub analysis of the MR. CLEAN trial showed no effect on GA patients. This has changed the way many practices are performing IA-thrombectomies. However, there are benefits from GA that are lost including increased safety in catheterization and optimization of reperfusion that must be re-considered.
Learning Objectives: Discuss the impact of GA on IA-thrombectomy for ischemic stroke
References: Berkhemer OA, van den Berg LA, Fransen PSS, Beumer D, Linsma HF, va Zwam WH, Dippel DW, van der Lugt A, van Oostenbrugge RJ, Majoi CBL, Roos YBW. Impact of General Anesthesia on Treatment Effect in the MR Clean trial - a post-hoc analysis. International Stroke Conference 2015. Nashville, TN.
Brinjikji W, Murad MH, Rabinstein AA, Cloft HJ, Lnzino G, Kallmes DF. Conscious sedation versus general anesthesia during endovascular acute ischemic stroke treatment: a systemic review and meta analysis. AJNR Am J Neruoradiol. 2015 Mar;36(3):525-9.