title: General Anesthesia Versus Conscious Sedation in Acute Stroke Treatment: The Importance of Head Immobilization.
abstract: OBJECTIVE
  While today mechanical thrombectomy is an established treatment option for main branch occlusions in anterior circulation stroke, there is still an ongoing debate on the kind of anesthesia to be preferred. Introducing a simple method for head stabilization, we analyzed safety and duration of endovascular recanalization procedures under general anesthesia (GA) and conscious sedation (CS).
  
  
  METHODS
  We retrospectively identified 84 consecutive patients who underwent mechanical thrombectomy owing to acute anterior circulation stroke. Fifty-three were treated under GA and 31 under CS equipped with a standard cervical collar to reduce head movement. We evaluated recanalization results, in-house time to start recanalization, procedure times, technical and clinical complication rates, and conversion rates from CS to GA.
  
  
  RESULTS
  Recanalization of mTICI ≥2b was achieved in 80 % under CS and in 81 % under GA. Median in-house time to start recanalization for CS was 60 min (IQR 28; 44-72) and 77 min (IQR 23; 68-91) for GA (P = 0.001). Median procedure time under CS was 35 min (IQR 43; 69-25) and 41 min (IQR 43; 66-23) for GA (P = 0.9). No major complications such as ICH occurred in either group, and no conversions from CS to GA were necessary.
  
  
  CONCLUSIONS
  Mechanical thrombectomy can be performed faster and safely under CS in combination with simple head immobilization using a standard cervical collar.
authors.affiliation: Department of Neuroradiology, Ludwig-Maximilians-University Hospital, Marchioninistr 15, 81377, Munich, Germany. hendrik.janssen@med.uni-muenchen.de.
authors.forename: H
authors.initials: H
authors.lastname: Janssen
authors.affiliation: Department of Neurology, Ludwig-Maximilians-University Hospital, Marchioninistr 15, 81377, Munich, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Buchholz
authors.affiliation: Neurology/Research Institute of Neurointervention, Paracelsus Medical University, Ignaz Harrer Str. 79, 5020, Salzburg, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Killer
authors.affiliation: Department of Neuroradiology, Ludwig-Maximilians-University Hospital, Marchioninistr 15, 81377, Munich, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Ertl
authors.affiliation: Department of Neuroradiology, Ludwig-Maximilians-University Hospital, Marchioninistr 15, 81377, Munich, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Brückmann
authors.affiliation: Department of Neuroradiology, Ingolstadt Hospital, Krumenauerstraße 25, 85049, Ingolstadt, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Lutz
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006257:Head / Q000601:surgery; D006801:Humans; D007103:Immobilization / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000601:surgery*; D013523:Surgical Equipment; D017131:Thrombectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Anesthesia; Stroke; Thrombectomy