title: [Endovascular treatment of acute ischemic stroke under conscious sedation compared to general anesthesia - safety, feasibility and clinical and radiological outcome].
abstract: OBJECTIVE
  Vessel recanalization is an important predictor of clinical outcome in the treatment of acute ischemic stroke. Endovascular therapies are used with increasing frequency. There is no general agreement on the policy of anesthesia during endovascular therapy, ranging from general anesthesia (GA) to local anesthesia at the puncture site with conscious sedation (CS) as needed. The aim of the study was to evaluate the safety and feasibility and radiological and clinical outcome of endovascular stroke therapy under CS.
  
  
  METHODS
  We retrospectively included all patients with acute ischemic stroke who were treated with endovascular therapy over a five-year period. Data was evaluated with respect to type of sedation, conversion from CS to GA, recanalization rate, infarct volume and peri- and post-procedural complications.
  
  
  RESULTS
  There was a technical failure in 7 patients. Of the remaining 124 patients (mean age 68.8 ± 14.6 years), 65 were female (52 %). The site of occlusion was located in the anterior circulation in 94 patients (76 %) and in the posterior circulation in 30 cases (24 %). 105 patients (85 %) were treated under CS and 16 cases (13 %) primarily under GA. In 3 cases (2 %) peri-procedural conversion to GA was necessary. Primary intra-arterial thrombolysis, mechanical recanalization only, and combination therapy were performed in 60 (48 %), 27 (22 %) and 37 (30 %) patients, respectively. There were no significant differences for recanalization rate and complications between GA and CS. The mean procedure time was significantly shorter in patients treated under CS (p < 0.01).
  
  
  CONCLUSIONS
  Endovascular stroke therapy with CS is feasible, can be performed safely and is faster than with GA.
authors: Institut für Diagnostische Radiologie und Neuroradiologie, Universitätsmedizin Greifswald, Germany.
authors: S
authors: S
authors: Langner
authors: A V
authors: AV
authors: Khaw
authors: T
authors: T
authors: Fretwurst
authors: A
authors: A
authors: Angermaier
authors: N
authors: N
authors: Hosten
authors: M
authors: M
authors: Kirsch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D002533:Cerebral Angiography / Q000295:instrumentation / Q000379:methods; D003131:Combined Modality Therapy; D016292:Procedural Sedation; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020243:Infarction, Anterior Cerebral Artery / Q000628:therapy*; D020762:Infarction, Posterior Cerebral Artery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017131:Thrombectomy; D015912:Thrombolytic Therapy / Q000295:instrumentation / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D010959:Tissue Plasminogen Activator