AUTHOR=Weyland Charlotte Sabine , Chen Min , Potreck Arne , Jäger Laura Bettina , Seker Fatih , Schönenberger Silvia , Bendszus Martin , Möhlenbruch Markus 

TITLE=Sedation Mode During Endovascular Stroke Treatment in the Posterior Circulation—Is Conscious Sedation for Eligible Patients Feasible?

JOURNAL=Frontiers in Neurology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.711558

DOI=10.3389/fneur.2021.711558

ISSN=1664-2295

ABSTRACT=<p><bold>Background and Purpose:</bold> To compare safety and efficacy of conscious sedation (CS) vs. general anesthesia (GA) in endovascular stroke treatment (EST) of the posterior circulation (PC).</p><p><bold>Methods:</bold> Retrospective single-center analysis of patients receiving EST for large-vessel occlusion (LVO) in PC between January 2015 and November 2020. Exclusion criteria were severe stroke syndromes (NIHSS &gt; 20), decreased level of consciousness, intubation for transport, and second stroke within 3 months of follow-up. The primary endpoint was a favorable clinical outcome 90 days after stroke onset (mRS 0–2 or 3 if pre-stroke mRS 3). Secondary endpoints were the rate of EST failure and procedural complications.</p><p><bold>Results:</bold> Of 111 included patients, 45/111 patients (40.5%) were treated under CS and 60/111 (54.0%) under GA. In 6/111 cases (5.4%), sedation mode was changed from CS to GA during EST. Patients treated under CS showed a lower mRS 90 days after stroke onset [mRS, median (IQR): 2.5 (1–4) CS vs. 3 (2–6) GA, <italic>p</italic> = 0.036] and a comparable rate of good outcome [good outcome, <italic>n</italic> (%): 19 (42.2) CS vs. 15 (32.6) GA, <italic>p</italic> = 0.311]. There was no difference in complication rates during EST (6.7% CS vs. 8.3% GA) or intracranial bleeding in follow-up imaging [<italic>n</italic> (%): 4 (8.9) CS vs. 7 (11.7) GA), <italic>p</italic> = 0.705]. The rate of successful target vessel recanalization did not differ (84.4% CS vs. 85.0 % GA).</p><p><bold>Conclusions:</bold> In this retrospective study, EST of the posterior circulation under conscious sedation was for eligible patients comparably safe and effective to patients treated under general anesthesia.</p>