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ORIGINAL ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 3  |  Page : 201-206

Disparities among neurointerventionalists suggest further investigation of conscious sedation versus general anesthesia during thrombectomy for acute stroke


1 Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston; Department of Neurology, McGovern Medical School, Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston; Department of Biomedical Informatics, School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
2 Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
3 Research Operations and Conduct, University of Chicago, Chicago, Illinois, USA
4 Department of Neurology, McGovern Medical School, Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center at Houston, Houston, TX, USA
5 Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
6 Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA

Correspondence Address:
Peng Roc Chen
6400 Fannin Street, Suite 2800, Houston, TX 77030
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bc.bc_19_21

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INTRODUCTION: Prior retrospective and case-control studies have shown that the use of general anesthesia (GA) during endovascular therapy (EVT) for acute ischemic stroke with large vessel occlusion (AIS-LVO) was independently associated with poor clinical outcomes compared with cases performed under conscious sedation (CS). Conversely, recent small randomized clinical trials (RCT) demonstrated a trend toward better outcome in cases performed under GA. METHODS: We submitted an online survey to 193 Society of Vascular Interventional Neurology and 78 American Association of Neurological Surgeons and Congress of Neurological Surgeons – Cerebrovascular Section neuroendovascular practitioners. Questions were aimed at understanding the current state of anesthesia practice during EVT, and to determine if there is clinical equipoise for a large multicenter RCT comparing GA versus CS during EVT. RESULTS: Between March and May of 2017, we received 116 (43%) responses. Anesthesiologists were responsible for managing 96% of the GA cases as compared to only 51% of the CS cases (P < 0.0001). Notable 56% of providers reported performing less than a quarter of their cases under GA. Only 7% performed all cases under GA compared with 17% who used solely CS (P = 0.048). More than half of respondents thought a new RCT was necessary, of whom 61% were interested in participating. Among interested responders, 59% were located in centers with 3 or more neurointerventionalists. CONCLUSION: The significant variation among neuroendovascular providers, added with the lack of consensus among recent trials and meta-analyses, demonstrate clinical equipoise for further studies to explore the effects of anesthesia during EVT in AIS-LVO.


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