Outcomes following thrombectomy for acute ischemic stroke using procedural sedation with midazolam

Abstract

Although the effectiveness of thrombectomy has become clear, there is no consensus on whether sedation should be performed under general anesthesia or procedural sedation. Midazolam is used to achieve mild sedation during invasive treatments and examinations. This study aimed to investigate the treatment outcomes of thrombectomy under mild sedation using midazolam and report them retrospectively. This study included 100 cases of acute occlusion of the anterior circulation of intracranial vessels with a National Institutes of Health Stroke Scale (NIHSS) score of 10 or more who underwent thrombectomy under sedation using midazolam at our hospital between 2023 and 2024. The average age of the patients was 79.0 ± 12.2 years, and the preoperative NIHSS score was 19.8 ± 6.4. In total, 92 cases (92.0%) with modified Thrombolysis in Cerebral Infarction 2B or higher recovered with an average time from puncture to recanalization of 32 ± 23 min, and 52 cases (52.0%) had a favorable outcome (modified Rankin Scale 0-2) 3 months later. Anesthesia-related complications included postoperative pneumonia in seven cases (7.0%), and procedural complications included symptomatic intracranial hemorrhage due to perforation of intracranial vessels by the microguidewire in one case (1.0%). Nine patients (9.0%) died 3 months after surgery. Thrombectomy under procedural sedation using midazolam achieves favorable outcomes owing to favorable and rapid recanalization. In addition, there are few procedural complications due to body movement and few anesthesia-related complications due to sedation, making this a safe method.

Keywords: Thrombectomy; anesthesia; complications; midazolam; procedural sedation.