title: Conscious sedation versus general anesthesia during endovascular therapy for acute anterior circulation stroke: preliminary results from a retrospective, multicenter study.
abstract: OBJECTIVE
  Patients undergoing intra-arterial therapy (IAT) for acute ischemic stroke receive either general anesthesia (GA) or conscious sedation. GA may delay time to treatment, whereas conscious sedation may result in patient movement and compromise the safety of the procedure. We sought to determine whether there were differences in safety and outcomes in GA patients before initiation of IAT.
  
  
  METHODS
  A cohort of 980 patients at 12 stroke centers underwent IAT for acute stroke between 2005 and 2009. Only patients with anterior circulation strokes due to large-vessel occlusion were included in the study. A binary logistic-regression model was used to determine independent predictors of good outcome and death.
  
  
  RESULTS
  The mean age was 66+/-15 years and median National Institutes of Health Stroke Scale score was 17 (interquartile range, 13-20). The overall recanalization rate was 68% and the symptomatic hemorrhage rate was 9.2%. GA was used in 44% of patients with no differences in intracranial hemorrhage rates when compared with the conscious sedation group. The use of GA was associated with poorer neurologic outcome at 90 days (odds ratio=2.33; 95% CI, 1.63-3.44; P<0.0001) and higher mortality (odds ratio=1.68; 95% CI, 1.23-2.30; P<0.0001) compared with conscious sedation.
  
  
  CONCLUSIONS
  Patients placed under GA during IAT for anterior circulation stroke appear to have a higher chance of poor neurologic outcome and mortality. There do not appear to be differences in hemorrhagic complications between the 2 groups. Future clinical trials with IAT can help elucidate the etiology of the differences in outcomes.
authors.affiliation: Department of Neurology, Vanderbilt Stroke Center, A-0118 Medical Center North, Nashville, TN 37232-2551, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Abou-Chebl
authors.forename: Ridwan
authors.initials: R
authors.lastname: Lin
authors.forename: Muhammad Shazam
authors.initials: MS
authors.lastname: Hussain
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Hsu
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Rymer
authors.forename: Ashis H
authors.initials: AH
authors.lastname: Tayal
authors.forename: Osama O
authors.initials: OO
authors.lastname: Zaidat
authors.forename: Sabareesh K
authors.initials: SK
authors.lastname: Natarajan
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
authors.forename: Ashish
authors.initials: A
authors.lastname: Nanda
authors.forename: Melissa
authors.initials: M
authors.lastname: Tian
authors.forename: Qing
authors.initials: Q
authors.lastname: Hao
authors.forename: Junaid S
authors.initials: JS
authors.lastname: Kalia
authors.forename: Thanh N
authors.initials: TN
authors.lastname: Nguyen
authors.forename: Michael
authors.initials: M
authors.lastname: Chen
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D002545:Brain Ischemia / Q000473:pathology* / Q000628:therapy*; D015331:Cohort Studies; D016292:Procedural Sedation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate