Local Anesthesia or Conscious Sedation in Mechanical Thrombectomy
Melanie R. F. Greenway, MD
Benvegnù F, Richard S, Marnat G, Bourcier R, Labreuche J, Anadani M, Sibon I, Dargazanli C, Arquizan C, Anxionnat R, et. al. Local Anesthesia Without Sedation During Thrombectomy for Anterior Circulation Stroke is Associated with Worse Outcome. Stroke. 2020;51:2951-2959.
As mechanical reperfusion therapy continues to advance, questions regarding procedural methods of anesthesia continue to arise. This article compares functional outcomes in patients who received local anesthesia or conscious sedation for mechanical thrombectomy in acute ischemic stroke.
Utilizing the Endovascular Treatment in Ischemic Stroke Registry (ETIS) in France, the authors evaluated 1034 patients with large vessel occlusion admitted for mechanical thrombectomy from January to December 2018 at 4 centers. Three centers used a protocol with conscious sedation as the first-line treatment approach for mechanical thrombectomy, while one center used local anesthesia as the first-line treatment approach. After excluding patients because of missing information, absence of large vessel occlusion, or other exclusion criteria, 636 patients from the conscious sedation centers and 238 from the local anesthesia center were included in the intention-to-treat analysis. From there, 577 patients in the conscious sedation group and 185 patients from the local anesthesia group were included in the per-protocol analysis, as additional patients were excluded because of a change to their anesthesia management after enrollment.