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=Volume 12 - 2021

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=Background and Purpose:
To compare safety and efficacy of conscious sedation (CS) vs. general anesthesia (GA) in endovascular stroke treatment (EST) of the posterior circulation (PC).
Methods:
Retrospective single-center analysis of patients receiving EST for large vessel occlusion (LVO) in PC between 01/2015 and 11/2020. Exclusion criteria were severe stroke syndromes (NIHSS > 20), intubation for transport, simultaneous LVO of the anterior circulation, second stroke within 3 months of follow-up. Primary endpoint of this study 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 the procedural complication rate. 
Results:
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 higher mRS 90 days after stroke onset (mRS, median (IQR): 2.5 (1-4) CS vs. 4 (2-6) GA, p = 0.008) and a comparable rate of good outcome (good outcome, n (%): 19 (42.2) CS vs. 18 (30.0), p = 0.143). There was no difference in complication rates during EST (6.7% CS vs. 8.3 % GA) or intracranial bleeding in follow-up imaging (n (%): 4 (8.9) CS vs. 7 (11.7) GA), p = 0.705). The rate of successful target vessel recanalization was comparable (84.4 % CS vs. 85.0 % GA).  
Conclusion: 
In this retrospective analysis EST of the posterior circulation for eligible patients under conscious sedation or general anesthesia was comparably safe and effective.