Abou-Chebl1919 Abou-Chebl A, Lin R, Hussain MS, et al. Conscious sedation versus general anesthesia during endovascular therapy for acute anterior circulation stroke preliminary results from a retrospective, multicenter study. Stroke. 2010;41:1175-9. 2010 |
Retrospective, multicentric (12 centers) |
980 |
Anterior circulation large-vessel occlusion strokes |
GA vs. CS |
GA associated with: poorer neurological outcome at 90 days; higher mortality. |
Retrospective and non randomized nature |
No difference in hemorrhagic complications. |
GA - more likely to have carotid terminus occlusions and higher baseline NIHSS scores |
Abou-Chebl3838 Abou-Chebl A, Yeatts SD, Yan B, et al. Impact of general anesthesia on safety and outcomes in the endovascular arm of Interventional Management of Stroke (IMS) III Trial. Stroke. 2015;46:2142-8. 2015 |
Retrospective, multicentric (58 centers; cohort from IMS III trial) |
434 |
Anterior, middle and posterior circulation strokes |
GA vs. LA |
GA associated with: worse neurological outcomes; increased mortality |
Retrospective and non-randomized nature. |
LA - lower NIHSS scores. |
Abou-Chebl3737 Abou-Chebl A, Zaidat OO, Castonguay AC, et al. North American SOLITAIRE Stent-Retriever Acute Stroke Registry: choice of anesthesia and outcomes. Stroke. 2014;45:1396-401. 2014 |
Retrospective, multicentric (18 centers) |
281 |
Anterior and posterior circulation strokes |
GA vs. LA |
GA associated with: worse neurological outcomes; higher mortality |
Retrospective and non randomized nature |
No difference in intracranial hemorrhage risk |
LA - lower NIHSS scores |
Jumaa1717 Jumaa MA, Zhang F, Ruiz-Ares G, et al. Comparison of safety and clinical and radiographic outcomes in endovascular acute stroke therapy for proximal middle cerebral artery occlusion with intubation and general anesthesia versus the nonintubated state. Stroke. 2010;41:4-1180. 2010 |
Retrospective, monocentric |
126 |
Occlusion of the M1 segment of the middle cerebral artery |
Intubated (IS) vs. Non-intubated (NIS) |
IS associated with: greater final infarct volume; worse outcomes; higher in-hospital mortality |
Retrospective and non randomized nature |
Small sample size |
IS - higher baseline NIHSS scores |
van den Berg1515 van den Berg LA, Koelman DL, Berkhemer OA, et al. Type of anesthesia and differences in clinical outcome after intra-arterial treatment for ischemic stroke. Stroke. 2015;46:1257-62. 2015 |
Retrospective, multicentric (16 centers; cohort from MR CLEAN trial) |
348 |
Anterior circulation stroke |
Ga vs. non-GA |
GA associated with worse outcomes |
Retrospective and non randomized nature - possible selection bias |
Inequality in group sizes (non-GA 278 vs. GA 70). |
Davis44 Davis MJ, Menon BK, Baghirzada LB, et al. Anesthetic management and outcome in patients during endovascular therapy for acute stroke. Anesthesiology. 2012;116:396-405. 2012 |
Retrospective, monocentric |
96 |
Large vessel occlusion |
GA vs. LA (with or without CS, as needed) |
GA associated with: worse outcomes; higher mortality |
Retrospective and non randomized nature |
GA - more severe strokes |
Nichols55 Nichols C, Carrozzella J, Yeatts S, et al. Is periprocedural sedation during acute stroke therapy associated with poorer functional outcomes?. J Neurointerv Surg. 2010;2:67-70.
2010 |
Retrospective, multicentric (13 centers; cohort from IMS II Study) |
75 |
Anterior circulation stroke |
No sedation, mild sedation, heavy sedation, pharmacological paralysis |
Mild or no sedation associated with: higher rate of good outcomes; lower mortality; higher angiographic reperfusion rates |
Retrospective and non randomized nature |
Small sample size |
Baseline NIHSS varied significantly between different levels of sedation (higher in deeper sedation categories) |
John66 John S, Thebo U, Gomes J, et al. Intra-arterial therapy for acute ischemic stroke under general anesthesia versus monitored anesthesia care. Cerebrovasc Dis. 2014;38:262-7.
2014 |
Retrospective, monocentric |
190 |
Anterior circulation stroke |
GA vs. MAC |
GA associated with: higher mortality; higher rate of parenchymal hematomas |
Retrospective and non randomized nature - possible selection bias |
No statistical difference in outcomes between groups |
Li3636 Li F, Deshaies EM, Singla A, et al. Impact of anesthesia on mortality during endovascular clot removal for acute ischemic stroke. J Neurosurg Anesthesiol. 2014;26:286-90.
2014 |
Retrospective, monocentric |
109 |
Anterior, middle and posterior circulation strokes |
GA vs. CS |
GA associated with: higher mortality; longer door-to-recanalization time |
Retrospective and non randomized nature |
Small sample size |
Lack of long-term clinical follow-up at 90 days |
Sugg3232 Sugg RM, Jackson AS, Holloway W, et al. Is mechanical embolectomy performed in nonanesthetized patients effective?. AJNR Am J Neuroradiol. 2010;31:1533-5.
2010 |
Retrospective, monocentric |
66 |
Anterior, middle and posterior circulation strokes |
GA vs. non-anesthetized |
Nonanesthetized associated with: better outcome; lower complication rate |
Retrospective and non randomized nature |
Small sample size |
GA - older and higher baseline NIHSS scores |
Just3939 Just C, Rizek P, Tryphonopoulos P, et al. Outcomes of general anesthesia and conscious sedation in endovascular treatment for stroke. Can J Neurol Sci. 2016;43:655-8.
2016 |
Retrospective, monocentric |
109 |
Anterior, middle and posterior circulation strokes |
GA vs. CS |
GA associated with: higher mortality at hospital discharge, 3 months and 6 months poststroke onset; greater morbidity |
Retrospective and non randomized nature |
Long duration of the study (2000-2013) - technology and technique have evolved significantly over the course of the study |
Did not study hypotension |
Schonenberger1111 Schonenberger S, Uhlmann L, Hacke W, et al. Effect of conscious sedation vs general anesthesia on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy: a randomized clinical trial. JAMA. 2016;316:1986-96.
2016 |
Prospective, monocentric |
150 |
Anterior circulation stroke |
GA vs. CS |
No statistical difference in primary outcome (early neurological improvement) |
Single center |
Anesthesiologists more experienced on GA |
No difference in mortality |
Small sample size |
Hendén1212 Lowhagen Henden P, Rentzos A, Karlsson JE, et al. General anesthesia versus conscious sedation for endovascular treatment of acute ischemic stroke: an stroke trial (Anesthesia During Stroke). Stroke. 2017;48:1601-7. 2017 |
Prospective, monocentric |
90 |
|
GA vs. CS |
No statistical difference in neurological outcome 3 months after stroke or in mTICI 2b/3 recanalization |
Single center |
Small sample size |
Simonsen1313 Simonsen CZ, Yoo AJ, Sorensen LH, et al. Effect of general anesthesia and conscious sedation during endovascular therapy on infarct growth and clinical outcomes in acute ischemic stroke: a randomized clinical trial. JAMA Neurol. 2018;75:470-7. 2018 |
Prospective, monocentric |
128 |
|
GA vs. CS |
No statistical difference in primary outcome (infart growth during endovascular treatment) nor in safety endpoints |
Single center |
The primary endpoint was infarct growth - no definitive conclusions regarding clinical outcomes |
GA associated with lower 90 day mRS scores |
Small sample size |