title: Conscious sedation versus general anaesthesia during mechanical thrombectomy for stroke: a propensity score analysis.
abstract: BACKGROUND
  Debate exists as to whether patients with acute ischemic stroke who are undergoing mechanical thrombectomy should receive general anaesthesia or conscious sedation during the procedure. Using a multihospital administrative database, we compared outcomes and complications of patients receiving mechanical thrombectomy, who were receiving general anaesthesia and conscious sedation, and studied trends in usage over time.
  
  
  METHODS
  Premier database patients who underwent mechanical thrombectomy from 2006 to 2013 for acute ischemic stroke were identified. Using propensity score analysis, recipients of general anaesthesia and conscious sedation underwent 1:1 matching. Outcomes including usage trends, discharge status, mortality, length of stay, haemorrhage and pneumonia were examined.
  
  
  RESULTS
  A total of 2512 patients receiving mechanical thrombectomy were identified. 1999 (80%) received general anaesthesia and 513 (20%) received conscious sedation. Following 1:1 matching by the propensity score matching, 507 general anaesthesia and 507 conscious sedation patients were matched. Patients who received general anaesthesia during their procedure had significantly higher rates of in-hospital mortality (25% vs 12%, OR=2.37 95% CI 1.68 to 3.37, p<0.0001), and pneumonia (17.0% vs 9.3%, OR=2.0, 95% CI 1.35 to 2.96, p=0.0005) compared with patients of thrombectomy who received conscious sedation. ICH/SAH rates were similar between patients receiving general anaesthesia and patients receiving conscious sedation (11% vs 12%, p=0.62). Usage rate of general anaesthesia decreased from 83.8% in 2006 and 74.0% in 2013.
  
  
  CONCLUSIONS
  In our cohort, thrombectomy patients receiving conscious sedation have decreased in-hospital mortality, decreased rates of pneumonia, and lower hospital costs and lengths of stay when compared with patients who received general anaesthesia. However, most practitioners continue to use general anaesthesia in the setting of acute stroke interventions.
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: McDonald
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Cloft
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Kallmes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects*; D002545:Brain Ischemia / Q000601:surgery*; D016292:Procedural Sedation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D057216:Propensity Score; D020521:Stroke / Q000601:surgery*
keywords: Complication; Stroke