[Anesthesia of the endovascular treatment of ischemic strokes due to large vessel occlusion].

Abstract

Endovascular therapy for ischemic stroke with large vessel occlusion can be performed with either sedation without intubation or general anesthesia with intubation. According to current guidelines, decision should be made on individual basis, depending on clinical situation. Both methods have advantages and disadvantages, however, anesthetic practice varies from center to center and the nomenclature is often not uniform. In recent years, the term Monitored Anesthesia Care has been used worldwide in neurointervention to denote sedation and stabilization in urgent situations in a potentially unstable stroke patient. Since the introduction of endovascular therapy, studies comparing the two anesthetic techniques have yielded contradictory results so far, and in the meantime, the importance of anesthesia has been reassessed. In the years surrounding the introduction of mechanical thrombectomy in 2015, observational and retrospective studies have associated general anesthesia with worse functional stroke outcomes compared to sedation, mainly due to the associated time delay and more frequent hypotensive periods. Later randomized controlled trials designed to compare anesthetic methods showed no difference in outcome between general anesthesia and sedation. Moreover, concordant results of different trials showed that mechanical thrombectomy with general anesthesia had better recanalization rates, and some studies also reported better functional outcome. The true benefit of general anesthesia can only be realised in stroke centers where a neuroanesthesia team is continuously available, and also intrahospital care coordination and hemodynamic protocols are in place to minimize time delay and hypotensive period rates during general anesthesia. Orv Hetil. 2024; 165(51): 1997–2007.