Abstract WMP85: Outcomes in Transitioning From First-Line Conscious Sedation to General Anesthesia for Endovascular Thrombectomy

Abstract

Background: Endovascular thrombectomy (EVT) is the standard of care for patients with large vessel occlusion stroke with salvageable penumbra. Recent meta-analysis of randomized clinical trials showed general anesthesia (GA) improved successful recanalization by 9% and functional independence by 8.4%.(1) In our comprehensive stroke center we transitioned from first-line conscious sedation (CS) to GA in q4 2017. Methods: Retrospective analysis of 505 patients undergoing EVT from January 2015 to May 2020 was performed. Demographics, procedural variables, and modified Rankin scale (mRS) at discharge were collected for each year. We appropriately used ANOVA and Chi-square tests to compare the variables for each year. Results: Median age was 72[61-82], 258(51%) male and median NIHSS was 17[10-20]. Average door-to-puncture (DTP) time was 104.2±28 minutes and procedure time was 44±28.7 minutes. Median ICU length of stay was 3[1-5] days. There was no difference in age, initial NIHSS, and DTP over the years. Average procedure time increased over the years, with 30.1min in 2015, 34min in 2016, 44.9min in 2017, 52.3min in 2018, 45.9min in 2019, and 50.4min in 2020[F (5, 499)=7.7, p<0.001]. Tukey's HSD indicated that the time was significantly higher when comparing years of CS(2015-2017) versus GA(2018-2020) (p< 0.001). Figure1 shows the distribution of cases, proportion of patients undergoing GA, successful recanalization (TICI 2c-3), and mRS 0-2 at discharge over the years. Successful recanalization was achieved in 129/218 (58%) patients with CS versus 198/287(69%) with GA(OR 0.7, CI 95%[0.5-0.9], P=0.02). MRS 0-2 at discharge was achieved in 71/218(33%) patients with CS versus 118/287(41%) with GA (OR 0.6, CI 95%[0.4-0.9], p=0.04). Conclusion: Overall, the rate of successful recanalization and mRS 0-2 at discharge significantly improved after the transition to GA. Though procedure time increased over the years, this did not affect outcomes.