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. 2024 Feb 12;16(3):230-236.
doi: 10.1136/jnis-2023-020210.

Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery

Lukas Meyer  1 , Christian Paul Stracke  2   3 , Gabriel Broocks  2 , Marta Wallocha  4 , Mohamed Elsharkawy  3 , Peter B Sporns  2   5 , Eike I Piechowiak  6 , Johannes Kaesmacher  6 , Christian Maegerlein  7 , Moritz Roman Hernandez Petzsche  7 , Hanna Zimmermann  8 , Weis Naziri  9   10 , Nuran Abdullayev  11 , Christoph Kabbasch  11 , Daniel Behme  12 , Maximilian Thormann  12 , Volker Maus  13 , Sebastian Fischer  13 , Markus A Möhlenbruch  14 , Charlotte Sabine Weyland  14 , Soenke Langner  15 , Marielle Ernst  16 , Ala Jamous  16 , Dan Meila  17 , Milena Miszczuk  18 , Eberhard Siebert  18 , Stephan Lowens  19 , Lars Udo Krause  20 , Leonard Ll Yeo  21   22 , Benjamin Y Q Tan  21   22 , Anil Gopinathan  22   23 , Benjamin Gory  24 , Jorge Galvan Fernandez  25 , Miguel Schüller Arteaga  25 , Pedro Navia  26 , Eytan Raz  27 , Maksim Shapiro  27 , Fabian Arnberg  28 , Kamil Zeleňák  29 , Mario Martínez-Galdámez  25 , Maria Alexandrou  30 , Andreas Kastrup  31 , Panagiotis Papanagiotou  30   32 , Franziska Dorn  33 , André Kemmling  34 , Marios-Nikos Psychogios  5 , Tommy Andersson  28   35 , René Chapot  4 , Jens Fiehler  2 , Uta Hanning  2 ; From the TOPMOST Study Group
Collaborators, Affiliations

Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery

Lukas Meyer et al. J Neurointerv Surg. .

Abstract

Background: Numerous questions regarding procedural details of distal stroke thrombectomy remain unanswered. This study assesses the effect of anesthetic strategies on procedural, clinical and safety outcomes following thrombectomy for distal medium vessel occlusions (DMVOs).

Methods: Patients with isolated DMVO stroke from the TOPMOST registry were analyzed with regard to anesthetic strategies (ie, conscious sedation (CS), local (LA) or general anesthesia (GA)). Occlusions were in the P2/P3 or A2-A4 segments of the posterior and anterior cerebral arteries (PCA and ACA), respectively. The primary endpoint was the rate of complete reperfusion (modified Thrombolysis in Cerebral Infarction score 3) and the secondary endpoint was the rate of modified Rankin Scale score 0-1. Safety endpoints were the occurrence of symptomatic intracranial hemorrhage and mortality.

Results: Overall, 233 patients were included. The median age was 75 years (range 64-82), 50.6% (n=118) were female, and the baseline National Institutes of Health Stroke Scale score was 8 (IQR 4-12). DMVOs were in the PCA in 59.7% (n=139) and in the ACA in 40.3% (n=94). Thrombectomy was performed under LA±CS (51.1%, n=119) and GA (48.9%, n=114). Complete reperfusion was reached in 73.9% (n=88) and 71.9% (n=82) in the LA±CS and GA groups, respectively (P=0.729). In subgroup analysis, thrombectomy for ACA DMVO favored GA over LA±CS (aOR 3.07, 95% CI 1.24 to 7.57, P=0.015). Rates of secondary and safety outcomes were similar in the LA±CS and GA groups.

Conclusion: LA±CS compared with GA resulted in similar reperfusion rates after thrombectomy for DMVO stroke of the ACA and PCA. GA may facilitate achieving complete reperfusion in DMVO stroke of the ACA. Safety and functional long-term outcomes were comparable in both groups.

Keywords: stroke; thrombectomy; thrombolysis.

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Conflict of interest statement

Competing interests: JF: Consulting fees from Cerenovus, Medtronic, Phenox, Penumbra, Roche, Tonbridge; participation on a Data Safety Monitoring Board of Stryker and Phenox; stock holdings for Tegus and Vastrax, Associate Editor for JNIS. RC: Consultant and/or proctor for BALT, Stryker, Microvention, Rapid Medical, Siemens Medical Systems. MM: Institutional grants: Balt, Medtronic, MicroVention, Stryker. AG: Proctor/consultant/speaker for Medtronic, Stryker and Penumbra. MM-G: Consultant for Medtronic, Stryker and Balt, Associate Editor for JNIS. FD: Grant from Cerenovus/ Johnson&Johnson, consulting fees from Cerus Endovascular, Balt, Cerenovus/Johnson&Johnson, honoraria for lectures Asahi, Cerenovus/Johnson&Johnson, Acandis, Stryker, Advisory Board Cerenovus Johnson&Johsno, Associate Editor for JNIS. JK: Grants from SAMW/Bangerter, grants from Swiss Stroke Society, and grants from Clinical Trial Unit Bern outside the submitted work. LLLY: Consultant for Stryker, SeeMode, and See-mode, Cerenovus honoraria, Jakarta Neuroupdate honorarium, Research Support from National Medical research Council (NMRC) Singapore and Ministry of Health (MOH). Stock holdings for Cereflo, SNVIS vice president. BT: Grants from ExxonMobil-NUS Research Fellowship for Clinicians. PN: Consultant/Proctor for Balt, Cerenovus, Medtronic, Penumbra, Stryker. AG: Honoraria for lectures from Stryker Neurovascular, Medtronic, Penumbra. BG: grants from the French Ministry of Health and is the primary investigator of the TITAN, DIRECT ANGIO, and IA-RESCUE trial; consulting fees from Air Liquide, MIVI, Medtronic, Microvention, and Penumbra. LM: Compensation as a speaker for Balt Prime. GB: Compensation as a speaker for Balt Prime.

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