Anesthetic Management of Emergency Endovascular Thrombectomy for Acute Ischemic Stroke, Part 2: Integrating and Applying Observational Reports and Randomized Clinical Trials

What is it about?

Endovascular thrombectomy (EVT) is a new x-ray guided procedure for patients with a stroke. EVT removes blood clots from brain blood vessels that prevent blood flow to the brain. Observational reports suggest outcomes were more favorable when EVT was performed with local anesthesia (with or without intravenous sedation) instead of general anesthesia (GA). However, these reports cannot be accepted at face value because, in many instances, EVT patients selected to receive GA had a greater incidence of risk factors for unfavorable outcome. When outcomes were adjusted for pre-EVT risk factors, the apparent adverse effect of GA has decreased over the years. The apparent adverse effect of GA may largely be due to delays in starting treatment and decreased blood pressure. Three recent randomized trials showed that when GA-associated delays and decreased blood pressure are minimized, outcome is not worse with GA.

Featured Image