Abstract No. 719 Conscious sedation versus general anesthesia on outcomes in mechanical thrombectomy for patients with acute ischemic stroke

Abstract

Workflow optimization is essential in the setting of mechanical thrombectomy for acute ischemic stroke (AIS). Either conscious sedation or general anesthesia can be used during intervention. The purpose was to study the differences between the type of anesthesia used and its impact on time to recanalization during mechanical thrombectomy. 94 patients between September 2017 and August 2019 presented to the emergency room (ER) with stroke-like symptoms. These patients were deemed eligible for mechanical thrombectomy by the stroke neurology service. The study group comprised of 58 males (ages 27-91) and 36 females (ages 46-92) with a median National Institutes of Health Stroke Scale (NIHSS) of 15 (range, 3-35). Anesthesia was either conscious sedation (CS) (n = 54) or general anesthesia (GA) (n = 40). CS comprised of fentanyl boluses with or without propofol or dexmedetomidine infusion. GA was either rapid sequence induction and intubation in the angiography suite (n = 26) or intubation in the ER (n = 14). Primary endpoint was time to recanalization, defined as a modified Treatment in Cerebral Ischemia (mTICI) ≥ 2b after intervention. Statistical analysis between groups was performed using the non-parametric Kruskal Wallis test, chi-square analysis, or z-score test for population proportions. Comparisons between anesthesia and intervention times indicate statistically significant lower door to groin puncture time (p≤0.016) by 39 minutes and door to recanalization time (p≤0.045) by 40.5 minutes between the CS and GA groups. Analysis for mortality shows statistically significant lower 7-day (22.5% vs. 3.7%, p≤0.005) and 30-day (25% vs. 5.5%, p≤0.007) mortality between the GA group and the CS group. Thirty-day mortality is statistically significant when comparing intubation in ER versus angiography suite within the GA group (36% vs. 11.5%, p≤0.06). Patients undergoing mechanical thrombectomy for acute ischemic stroke with conscious sedation had lower door to puncture times, lower mortality, and better radiographic recanalization compared to patients with general anesthesia. Our study supports the use of conscious sedation during thrombectomy over general anesthesia.Table 1Comparative Analysis of Time to Intervention Between General Anesthesia and Conscious Sedation for Mechanical ThrombectomyTime to Intervention (minutes) (median, IRQ)General Anesthesia (GA) (n = 40)Conscious Sedation (CS) (n = 54)P∗P ≤ 0.005 considered statistically signifcant.Door to puncture174.5 (140-238)135.5 (114-175)0.016*Table to puncture11 (8-15)10 (7-18)0.88Puncture to first pass32 (19-48) (90%)1Percentage of successful passes by group.29 (22-42) (87%)1Percentage of successful passes by group.0.66Puncture to recanalization48 (27-68) (70%)2Successful recanalization (mTICI ≥ 2b) percentage by group.41 (30-61) (81%)2Successful recanalization (mTICI ≥ 2b) percentage by group.0.19Door to recanalization226 (171-279.5) (70%)2Successful recanalization (mTICI ≥ 2b) percentage by group.185.5 (150-215) (81%)2Successful recanalization (mTICI ≥ 2b) percentage by group.0.045*Stroke onset to puncture287 (208-615)290 (185-569)0.99Onset to recanalization336 (258-901)357 (242-608)0.65* P ≤ 0.005 considered statistically signifcant.1 Percentage of successful passes by group.2 Successful recanalization (mTICI ≥ 2b) percentage by group. Open table in a new tab