Effect of General Anesthesia Versus Conscious Sedation/Local Anesthesia on the Outcome of Patients with Minor Stroke and Isolated M2 Occlusion Undergoing Immediate Thrombectomy: A Retrospective Multicenter Matched Analysis
Iacopo Valente, Andrea Alexandre, Francesca Colò, Valerio Brunetti, Giovanni Frisullo, Arianna Camilli, Anne Falcou, Luca Scarcia, Riccardo Gigli, Irene Scala, Pier Andrea Rizzo, Serena Abruzzese, Luca Milonia, Mariangela Piano, Antonio Macera, Maria Ruggiero, Valerio Da Ros, Luigi Bellini, Guido Andrea Lazzarotti, Mirco Cosottini, Antonio Armando Caragliano, Sergio Lucio Vinci, Joseph Gabrieli, Francesco Causin, Pietro Panni, Luisa Roveri, Nicola Limbucci, Francesco Arba, Leonardo Renieri, S. Ferretti, Marco Pileggi, Giovanni Bianco, Daniele Giuseppe Romano, Giulia Frauenfelder, Vittorio Semeraro, Maria P. Ganimede, Emilio Lozupone, Antonio Fasano, Elvis Lafe, Anna Cavallini, Federico Mazzacane, Riccardo Russo, Mauro Bergui, Aldobrando Broccolini, Alessandro Pedicelli
Abstract
BACKGROUND: This study investigates the impact of general anesthesia (GA) versus conscious sedation/local anesthesia (CS/LA) on the outcome of patients with minor stroke and isolated M2 occlusion undergoing immediate mechanical thrombectomy (iMT). METHODS: The databases of 16 comprehensive stroke centers were retrospectively screened for consecutive patients with isolated M2 occlusion and a baseline National Institutes of Health Stroke Scale score ≤5 who received iMT. Propensity score matching was used to estimate the effect of GA versus CS/LA on clinical outcomes and procedure-related adverse events. The primary outcome measure was a 90-day modified Rankin Scale (mRS) score of 0-1. Secondary outcome measures were a 90-day mRS score of 0-2 and all-cause mortality, successful reperfusion, procedural-related symptomatic subarachnoid hemorrhage, intraprocedural dissections, and new territory embolism. RESULTS: Of the 172 patients who were selected, 55 received GA and 117 CS/LA. After propensity score matching, 47 pairs of patients were available for analysis. We found no significant differences in clinical outcome, rates of efficient reperfusion, and procedural-related complications between patients receiving GA or LA/CS (mRS score 0-1, P = 0.815; mRS score 0-2, P = 0.401; all-cause mortality, P = 0.408; modified Treatment in Cerebral Infarction score 2b-3, P = 0.374; symptomatic subarachnoid hemorrhage, P = 0.082; intraprocedural dissection, P = 0.408; new territory embolism, P = 0.462). CONCLUSIONS: In patients with minor stroke and isolated M2 occlusion undergoing iMT, the type of anesthesia does not affect clinical outcome or the rate of procedural-related complications. Our results agree with recent data showing no benefit of one specific anesthesiologic procedure over the other and confirm their generalizability also to patients with minor baseline symptoms.