Abstract TP184: Outcomes and Clinical Features Associated With Emergency Conversion to General Anesthesia During Stroke Thrombectomy

Abstract

Introduction: Anesthesia options for ischemic stroke patients undergoing endovascular thrombectomy (MT) can include local anesthesia, conscious sedation, or general anesthesia. Recent meta-analyses show that patients requiring emergency conversion (EC) to general anesthesia (GET) have higher mRS post-discharge than non-converters. The aim of this study was to assess the immediate outcomes in EC patients and identify factors associated with EC risk. Methods: This retrospective study included 264 sequential patients undergoing MT for large vessel occlusion at a comprehensive stroke center. EC was defined as intra-procedural induction of GET during MT. Results: Twelve patients (4.5%) required EC to GET. Median times from puncture to first pass (49 vs. 27 mins) and puncture to reperfusion (88 vs. 47 mins) were nearly doubled in EC patients compared to non-converters. Though the median TICI scores were similar, EC patients required double the number of passes and experienced significantly more symptomatic hemorrhagic complications (OR 5.82; 95% CI 1.10-30.688; p=0.018). An increased trend towards in-hospital death was noted (OR 1.46; 95% CI 0.382-5.602; p=0.289). Tobacco use was the only correlated clinical factor reaching statistical significance (RR 2.05; 95% CI 0.878-4.783; p=0.048). Conclusion: Although EC patients have similar reperfusion scores based on radiographic criteria, more complications were observed, and nearly double the time was required for reperfusion. While there is no consensus on anesthesia type during MT, EC introduces unnecessary risk and should be avoided. Given the potential harm from EC, multidisciplinary communication prior to puncture is essential.