General Anesthesia Versus Conscious Sedation in Acute Stroke Treatment: The Importance of Head Immobilization

• Published in: Cardiovascular and interventional radiology 2016-09, Vol.39 (9), p.1239-1244
• Main Authors: Janssen, H., Buchholz, G., Killer, M., Ertl, L., Brückmann, H., Lutz, J.
• Format: Article
• Language: English
• Subjects: Aged; ANESTHESIA; Anesthesia, General - methods; BIOMEDICAL RADIOGRAPHY; Cardiology; Clinical Investigation; Conscious Sedation - methods; DIAGNOSIS; Endovascular Procedures - methods; Female; HEAD; Head - surgery; Humans; Imaging; Immobilization - methods; Male; Medicine; Medicine & Public Health; Nuclear Medicine; PATIENTS; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Retrospective Studies; SAFETY; STABILIZATION; Stroke - surgery; Surgical Equipment; Thrombectomy - methods; Time Factors; Treatment Outcome; Ultrasound; VASCULAR DISEASES; WHO
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-016-1411-5

Purpose While today mechanical thrombectomy is an established treatment option for main branch occlusions in anterior circulation stroke, there is still an ongoing debate on the kind of anesthesia to be preferred. Introducing a simple method for head stabilization, we analyzed safety and duration of endovascular recanalization procedures under general anesthesia (GA) and conscious sedation (CS). Methods We retrospectively identified 84 consecutive patients who underwent mechanical thrombectomy owing to acute anterior circulation stroke. Fifty-three were treated under GA and 31 under CS equipped with a standard cervical collar to reduce head movement. We evaluated recanalization results, in-house time to start recanalization, procedure times, technical and clinical complication rates, and conversion rates from CS to GA. Results Recanalization of mTICI ≥2b was achieved in 80 % under CS and in 81 % under GA. Median in-house time to start recanalization for CS was 60 min (IQR 28; 44–72) and 77 min (IQR 23; 68–91) for GA ( P  = 0.001). Median procedure time under CS was 35 min (IQR 43; 69–25) and 41 min (IQR 43; 66–23) for GA ( P  = 0.9). No major complications such as ICH occurred in either group, and no conversions from CS to GA were necessary. Conclusion Mechanical thrombectomy can be performed faster and safely under CS in combination with simple head immobilization using a standard cervical collar.