Introduction: Currently, there are two anesthetic approaches for patients undergoing Intra-arterial Mechanical Thrombectomy (IAMT): Conscious Sedation (CS) or General Anesthesia (GA). The superior approach is the subject of ongoing debate. Here, we present a series of 43 patients receiving either CS or GA.

Methods: This was a retrospective cohort study of 43 consecutive patients who received IAMT at our institution since 1/2013.

Results: From 1/2013 until present, 24 patients received CS and 19 patients received GA. The two groups were similar with respect to age (63±3.4 vs. 64.6±3.8 years; mean + SEM) and NIHSS at presentation (19.0±1.7 vs. 17.4±1.6). The time from CT to puncture was not found to be different between groups (93.0±12.3 vs. 95.3±9.9 minutes), nor was time from puncture to recanalization (54.5±6.3 vs. 48.8±7.1). Similarly, differences in length of stay (LOS), ICU LOS and NIHSS at 48 hours were all found to not be significant (8.5±1.1 vs. 10±1.3 days; 6.1±1.2 vs. 7.1±1.1 days; 18.4±2.2 vs. 17.7±2.0 respectively). True 3 month modified Rankin Score (mRS) were not available on some patients, however 3 month mRS estimates were obtained based on followup data. No significant differences were seen in mRS either. (CS - 21 patients; GA 12 patients; 4.4±0.4 vs. 4.75±0.5). However, a greater reperfusion rate, assessed by a TICI score of 2b or 3, was achieved in patients under GA (CS: 15 patients (62.5%) vs. GA: 17 patients (84.2%)). 5 patients who received CS (20.8%) and 3 patients who received GA (15.8%) expired during hospitalization.

Conclusions: Previous reviews have suggested poorer outcomes in patients undergoing GA for IAMT. Our study does not support that finding. There was no significant difference in NIHSS at 48 hours or 3 month mRS. We found GA did not delay the procedure or time to revascularization, but resulted in improved reperfusion rates.

Patient Care: This study further adds to the debate between administering general anesthesia vs. conscious sedation for patients undergoing thrombectomy during acute ischemic stroke. It is important to determine which type of sedation, if either, leads to improved long-term outcomes. Here, we show that each type of sedation is equivocal in outcomes, in terms of NIHSS at 48 hours after procedure and in terms of mRS at 3 months after procedure.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the pros and cons of both conscious sedation and general anesthesia in patients that undergo thrombectomy for acute ischemic stroke. 2) Discuss outcome differences in patients undergoing each type of sedation.

References: 1) Goyal et al. Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke. N Engl J Med 2015; 372:1019-1030, March 12, 2015. 2) Jovin et al. Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke. N Engl J Med 2015; 372:2296-2306, June 11, 2015. 3) Saver et al. Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke. N Engl J Med 2015; 372:2285-2295, June 11, 2015. 4) Berkhemer et al. A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke. N Engl J Med 2015; 372:11-20, January 1, 2015.