title: General Anesthesia During Endovascular Stroke Therapy Does Not Negatively Impact Outcome.
abstract: OBJECTIVE
  Recent randomized trials have demonstrated that endovascular therapy improves outcomes in patients with an acute ischemic stroke from a large vessel occlusion. Subgroup analysis of the Multicenter Randomized CLinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN) study found that patients undergoing general anesthesia (GA) for the procedure did worse than those with nongeneral anesthesia (non-GA). Current guidelines now suggest that we consider non-GA over GA, without large, randomized trials specifically designed to address this issue. We sought to review our experience and outcomes in a program where we routinely use GA in patients undergoing mechanical thrombectomy with similar techniques.
  
  
  METHODS
  Patients with anterior circulation strokes who received intravenous tissue plasminogen activator (IV-tPA) and endovascular stroke therapy were included in the analysis. The National Institutes of Health Stroke Scale (NIHSS) on admission and discharge and modified Rankin scale scores at discharge were recorded and compared with the outcome measurements of MR CLEAN.
  
  
  RESULTS
  Sixty patients were identified: 39 males and 21 females with a mean age of 62 (range of 29-88). Forty-seven patients were transferred from outside primary stroke centers, while 13 patients presented directly to our institution. Median NIHSS on admission was 15. The median time of symptom onset to endovascular therapy was 265 minutes, with an interquartile range of 81 minutes. Using the thrombolysis in cerebral infarction (TICI) scale, recanalization of TICI 2b-3 was achieved in 76.4% of recorded patients (42/55 recorded). At discharge, mortality was 16.7% (10/60), median NIHSS was 5, and 38.3% (23/60) of patients had a modified Rankin Scale score of 0-2.
  
  
  CONCLUSIONS
  General anesthesia does not worsen outcome in patients undergoing mechanical thrombectomy when compared to historical subgroups. Despite a longer time from symptom onset to treatment, our outcomes for patients receiving GA compare favorably to the GA and non-GA groups in MR CLEAN.
authors.affiliation: Department of Neurosurgery, Division of Cerebrovascular and Endovascular Neurosurgery, New York Medical College, Valhalla, New York, USA; Westchester NeuroVascular Institute, Westchester Medical Center, Valhalla, New York, USA. Electronic address: wanga@wcmc.com.
authors.forename: Arthur
authors.initials: A
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Division of Cerebrovascular and Endovascular Neurosurgery, New York Medical College, Valhalla, New York, USA.
authors.forename: Madison
authors.initials: M
authors.lastname: Stellfox
authors.affiliation: Department of Pathology, Division of Biostatistics and Epidemiology, New York Medical College, Valhalla, New York, USA.
authors.forename: Fred
authors.initials: F
authors.lastname: Moy
authors.affiliation: Department of Anesthesiology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.
authors.forename: Apolonia E
authors.initials: AE
authors.lastname: Abramowicz
authors.affiliation: Department of Neurosurgery, Division of Cerebrovascular and Endovascular Neurosurgery, New York Medical College, Valhalla, New York, USA; Westchester NeuroVascular Institute, Westchester Medical Center, Valhalla, New York, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Lehrer
authors.affiliation: Westchester NeuroVascular Institute, Westchester Medical Center, Valhalla, New York, USA.
authors.forename: Rivkah
authors.initials: R
authors.lastname: Epstein
authors.affiliation: Westchester NeuroVascular Institute, Westchester Medical Center, Valhalla, New York, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Eiden
authors.affiliation: Westchester NeuroVascular Institute, Westchester Medical Center, Valhalla, New York, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Aquilina
authors.affiliation: Department of Neurology, New York Medical College, Valhalla, New York, USA.
authors.forename: Noorie
authors.initials: N
authors.lastname: Pednekar
authors.affiliation: Department of Anesthesiology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.
authors.forename: Glenn
authors.initials: G
authors.lastname: Brady
authors.affiliation: Department of Anesthesiology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wecksell
authors.affiliation: Department of Anesthesiology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.
authors.forename: John
authors.initials: J
authors.lastname: Cooley
authors.affiliation: Department of Neurosurgery, Division of Cerebrovascular and Endovascular Neurosurgery, New York Medical College, Valhalla, New York, USA; Westchester NeuroVascular Institute, Westchester Medical Center, Valhalla, New York, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Santarelli
authors.affiliation: Capital Institute for Neurosciences, Stroke and Cerebrovascular Center, Capital Health System, Trenton, New Jersey, USA.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Stiefel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D002545:Brain Ischemia / Q000150:complications / Q000628:therapy*; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Endovascular thrombectomy; General anesthesia; Stroke