title: North American SOLITAIRE Stent-Retriever Acute Stroke Registry: choice of anesthesia and outcomes.
abstract: OBJECTIVE
  Previous work that predated the availability of the safer stent-retriever devices has suggested that general anesthesia (GA) may have a negative impact on outcomes in patients with acute ischemic stroke undergoing endovascular therapy.
  
  
  METHODS
  We reviewed demographic, clinical, procedural (GA versus local anesthesia [LA], etc), and site-adjudicated angiographic and clinical outcomes data from consecutive patients treated with the Solitaire FR device in the investigator-initiated North American SOLITAIRE Stent-Retriever Acute Stroke (NASA) Registry. The primary outcomes were 90-day modified Rankin Scale, mortality, and symptomatic intracranial hemorrhage.
  
  
  RESULTS
  A total of 281 patients from 18 centers were enrolled. GA was used in 69.8% (196/281) of patients. Baseline demographic and procedural factors were comparable between the LA and GA groups, except the former demonstrated longer time-to-groin puncture (395.4±254 versus 337.4±208 min; P=0.04), lower National Institutes of Health Stroke Scale (NIHSS; 16.2±5.8 versus 18.8±6.9; P=0.002), lower balloon-guide catheter usage (22.4% versus 49.2%; P=0.0001), and longer fluoroscopy times (39.5±33 versus 28±22.8 min; P=0.008). Recanalization (thrombolysis in cerebral infarction ≥2b; 72.94% versus 73.6%; P=0.9) and rate of symptomatic intracranial hemorrhage (7.1% versus 11.2%; P=0.4) were similar but modified Rankin Scale ≤2 was achieved in more LA patients, 52.6% versus 35.6% (odds ratio, 1.4 [1.1-1.8]; P=0.01). In multivariate analysis, hypertension, NIHSS, unsuccessful revascularization, and GA use (odds ratio, 3.3 [1.6-7.1]; P=0.001) were associated with death. When only anterior circulation and elective GA patients were included, there was a persistent difference in good outcomes in favor of LA patients (50.7% versus 35.5%; odds ratio, 1.3 [1.01-1.6]; P=0.04).
  
  
  CONCLUSIONS
  The NASA Registry has demonstrated that clinical outcomes and survival are significantly better in patients treated with LA, without increased symptomatic intracranial hemorrhage risk. Future trials should prospectively evaluate the effect of GA on outcomes.
authors.affiliation: From the Texas Stroke Institute, Plano, TX (A.A.-C., V.J.); Departments of Neurology, Neurosurgery, and Radiology, Medical College of Wisconsin/Froedtert Hospital, Atlanta, GA (O.O.Z., A.C.C., M.A.I.); Wellstar Neurosurgery Kennestone Hospital, Atlanta, GA (R.G.); Department of Neurology, Emory University School of Medicine, Atlanta, GA (C.-H.J.S. R.G.N.); Saint Luke's Kansas City, Kansas City, MO (C.O.M., W.E.H.); Department of Neurology, Delray Medical Center, Delray Beach, FL (N.M.-K.); California Pacific Medical Center, San Francisco, CA (J.D.E.); Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, FL (I.L., G.D.); Alexian Brothers Medical Center, Elk Grove Village, IL (T.W.M., F.A.M.); Oregon Health and Science University, Portland, OR (H.B.); Department of Neurology, Wayne State University School of Medicine, Detroit, MI (A.X.); Department of Radiology, West Virginia University Hospital, Morgantown, WV (A.T.R.); Departments of Neurology, Neurosurgery, Radiology, Vanderbilt University Medical Center, Nashville, TN (M.T.F.); Provena Saint Joseph Medical Center, Joliet, IL (A.B.); Departments of Neurology, Neurosurgery, Radiology, Boston Medical Center, Boston, MA (T.N.N.); Desert Regional Medical Center, Palm Springs, CA (M.T.); University of Kansas Medical Center, Kansas City, KS (M.G.A.); University of Texas Health Science Center, Houston, TX (H.S.); Departments of Radiology, Neurology, UT Southwestern Medical Center, Dallas, TX (R.N.); Department of Radiology, Division of Diagnostic and Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA (A.J.Y.); University of Texas, Houston, TX (P.R.C.); Department of Neurosurgery, Houston Methodist, Methodist Neurological Institute, Houston, TX (G.W.B.); Saint Louis University, St. Louis, MO (R.K.); and University of Missouri, Columbia, MO (A.N.).
authors.forename: Alex
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authors.lastname: Abou-Chebl
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authors.initials: WE
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authors.forename: Nils
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authors.lastname: Mueller-Kronast
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authors.lastname: English
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authors.lastname: Malisch
authors.forename: Franklin A
authors.initials: FA
authors.lastname: Marden
authors.forename: Hormozd
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authors.lastname: Bozorgchami
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authors.lastname: Xavier
authors.forename: Ansaar T
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authors.lastname: Rai
authors.forename: Micahel T
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authors.lastname: Froehler
authors.forename: Aamir
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authors.lastname: Badruddin
authors.forename: Thanh N
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authors.lastname: Nguyen
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authors.forename: Michael G
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authors.lastname: Abraham
authors.forename: Vallabh
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authors.lastname: Janardhan
authors.forename: Hashem
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authors.lastname: Shaltoni
authors.forename: Roberta
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authors.lastname: Novakovic
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
authors.forename: Peng R
authors.initials: PR
authors.lastname: Chen
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Britz
authors.forename: Ritesh
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authors.lastname: Kaushal
authors.forename: Ashish
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authors.lastname: Nanda
authors.forename: Mohammad A
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authors.forename: Raul G
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mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D000772:Anesthesia, Local / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D002545:Brain Ischemia / Q000401:mortality / Q000628:therapy*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America; D012042:Registries / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents / Q000706:statistics & numerical data*; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
keywords: anesthesia; stroke