Effect of Anesthesia on Outcomes of Endovascular Thrombectomy: A Randomized Clinical Trial

CV
Source: 
JAMA

Mechanical thrombectomy in select patients with acute ischemic stroke is a proven treatment. However, optimal anesthesia during this procedure is debated. Schonenberger et al. performed a prospective, randomized, blinded outcome trial assessing the use of general endotracheal anesthesia versus conscious sedation during stroke thrombectomy (SIESTA study).  150 patients with anterior circulation strokes in ICA and MCA vessels and NIHSS >10 were randomly assigned to each type of anesthesia.  Of 73 patients undergoing general anesthesia and 77 patients undergoing conscious sedation, there was no significant difference in primary outcome measure: change in 24 hour NIHSS (16.8 to 13.6 and 17.2 to 13.6, respectively).  Of the 47 pre-specified secondary outcome measures assessed, only six demonstrated a significant difference.  In favor of general anesthesia were less frequent movement and higher percentage of patients with a 90 day modified Rankin Scale 0-2.  In favor of conscious sedation were shorter door to puncture time, and fewer events of hypothermia, delayed extubation and ventilator-associated complications.  Analysis was performed as intention to treat.  Limitations include single center results that may not be generalizable.  In conclusion, the SIESTA study did not show improved 24 hour NIHSS for patients undergoing conscious sedation versus general anesthesia.  Future studies should include multiple centers and different types of local anesthesia or conscious sedation techniques.  

Michelle J. Smith, MD
Philadelphia, PA