Mechanical Thrombectomy Is a Tolerable Risk in Patients Undergoing Emergency Conversion to General Anesthesia

BACKGROUND AND PURPOSE: Mechanical thrombectomy for acute ischemic stroke is performed with the patient under local anesthesia, conscious sedation, or general anesthesia. According to recent trials, up to 16% of patients require emergency conversion to general anesthesia during mechanical thrombectomy. This study investigated the procedural and clinical outcomes after emergency conversion in comparison with local anesthesia, conscious sedation, and general anesthesia. MATERIALS AND METHODS: This retrospective study included 254 patients undergoing mechanical thrombectomy for acute large-vessel occlusion. The procedure was started with the patient either under local anesthesia, conscious sedation, or general anesthesia. Emergency conversion was de fi ned as induction of general anesthesia during mechanical thrombectomy. The primary outcomes were successful reperfusion (TICI 2b/3) and functional independence (mRS at 90days, # 2). RESULTS: Twenty-fi ve patients (9.8%) required emergency conversion to general anesthesia. The time from admission to fl ow restoration was increased under general anesthesia (median, 137minutes) and emergency conversion (median, 138minutes) compared with local anesthesia (median 110minutes). After adjustment for confounders, emergency conversion to general anesthesia and primary general anesthesia had comparable chances of successful reperfusion (OR = 1.28; 95% CI, 0.31 – 5.25). Patients with emergency conversion had a tendency toward higher chances of functional independence (OR= 4.48; 95% CI, 0.49 – 40.86) compared with primary general anesthesia, but not compared with local anesthesia (OR= 0.86; 95% CI, 0.14 – 5.11) and conscious sedation (OR= 1.07; 95% CI, 0.17 – 6.53). CONCLUSIONS: Patients with emergency conversion did not have lower chances of successful reperfusion or functional independence compared those with primary general anesthesia, and time to fl ow restoration was also similar. We found no evidence supporting the primary induction of general anesthesia in patients at risk for emergency conversion.

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