Sedation Mode During Endovascular Stroke Treatment in the Posterior Circulation-Is Conscious Sedation for Eligible Patients Feasible?

Charlotte Sabine Weyland, Min Chen, Arne Potreck, Laura Bettina Jäger, Fatih Seker, Silvia Schönenberger, Martin Bendszus, Markus Möhlenbruch, Charlotte Sabine Weyland, Min Chen, Arne Potreck, Laura Bettina Jäger, Fatih Seker, Silvia Schönenberger, Martin Bendszus, Markus Möhlenbruch

Abstract

Background and Purpose: To compare safety and efficacy of conscious sedation (CS) vs. general anesthesia (GA) in endovascular stroke treatment (EST) of the posterior circulation (PC). Methods: Retrospective single-center analysis of patients receiving EST for large-vessel occlusion (LVO) in PC between January 2015 and November 2020. Exclusion criteria were severe stroke syndromes (NIHSS > 20), decreased level of consciousness, intubation for transport, and second stroke within 3 months of follow-up. The primary endpoint was a favorable clinical outcome 90 days after stroke onset (mRS 0-2 or 3 if pre-stroke mRS 3). Secondary endpoints were the rate of EST failure and procedural complications. Results: Of 111 included patients, 45/111 patients (40.5%) were treated under CS and 60/111 (54.0%) under GA. In 6/111 cases (5.4%), sedation mode was changed from CS to GA during EST. Patients treated under CS showed a lower mRS 90 days after stroke onset [mRS, median (IQR): 2.5 (1-4) CS vs. 3 (2-6) GA, p = 0.036] and a comparable rate of good outcome [good outcome, n (%): 19 (42.2) CS vs. 15 (32.6) GA, p = 0.311]. There was no difference in complication rates during EST (6.7% CS vs. 8.3% GA) or intracranial bleeding in follow-up imaging [n (%): 4 (8.9) CS vs. 7 (11.7) GA), p = 0.705]. The rate of successful target vessel recanalization did not differ (84.4% CS vs. 85.0 % GA). Conclusions: In this retrospective study, EST of the posterior circulation under conscious sedation was for eligible patients comparably safe and effective to patients treated under general anesthesia.

Keywords: acute ischemic stroke; anesthesia management; conscious sedation; endovascular stroke therapy; mechanical thrombectomy; posterior circulation.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Weyland, Chen, Potreck, Jäger, Seker, Schönenberger, Bendszus and Möhlenbruch.

Figures

Figure 1
Figure 1
Patient selection for comparison of patients with stroke in the posterior circulation according to the applied mode of anesthesia. EST, endovascular stroke treatment; NIHSS, National Institute of Health Stroke Scale; LVO, large vessel occlusion.

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