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General Anesthesia Versus Conscious Sedation in Endovascular Thrombectomy for Stroke

A Meta-Analysis of 4 Randomized Controlled Trials

Campbell, Doug BM*; Diprose, William K. MBChB†,‡; Deng, Carolyn MBChB*; Barber, P. Alan MBChB, PhD, FRACP†,‡

doi: 10.1097/ANA.0000000000000646
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Background: In ischemic stroke patients, studies have suggested that clinical outcomes following endovascular thrombectomy are worse after general anesthesia (GA) compared with conscious sedation (CS). Most data are from observational trials, which are prone to measure and unmeasure confounding. We performed a systematic review and meta-analysis of thrombectomy trials where patients were randomized to GA or CS, and compared efficacy and safety outcomes.

Methods: The Medline, Embase, and Cochrane databases were searched for randomized controlled trials comparing GA to CS in endovascular thrombectomy. Efficacy outcomes included successful recanalization (Thrombolysis in Cerebral Infarction score of 2b to 3), and good functional outcome, defined as a modified Rankin Scale score of 0 to 2 at 3 months. Safety outcomes included intracerebral hemorrhage and 3-month mortality.

Results: Four studies were identified and included in the random effects meta-analysis. Patients treated with GA achieved a higher proportion of successful recanalization (odds ratio [OR]: 2.14, 95% confidence interval [CI]: 1.26-3.62; P=0.005) and good functional outcome (OR: 1.71, 95% CI: 1.13-2.59; P=0.01). For every 7.9 patients receiving GA, one more achieved good functional outcome compared with those receiving CS. There were no significant differences in intracerebral hemorrhage (OR: 0.61, 95% CI: 0.20-1.85; P=0.38) or 3-month mortality (OR: 0.62, 95% CI: 0.33-1.17; P=0.14) between GA and CS patients.

Conclusions: In centers with high quality, specialized neuroanesthesia care, GA treated thrombectomy patients had superior recanalization rates and better functional outcome at 3 months than patients receiving CS.

Departments of *Anaesthesia and Perioperative Medicine

Neurology, Auckland City Hospital

Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand

Presented at The 5th European Stroke Organisation Conference, Milan, 2019.

Supported by Neurological Foundation of New Zealand and Julius Brendel Trust.

The authors have no conflicts of interest to disclose.

Address correspondence to: P. Alan Barber, MBChB, PhD, FRACP. E-mail: a.barber@auckland.ac.nz.

Received June 19, 2019

Accepted August 29, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved