The use of conscious sedation (CS) versus general anesthesia (GA) for mechanical thrombectomy (MT) remains controversial. At our institution there was a change from anesthesia service involvement for some to all MT cases, which increased the percent of cases performed with GA (from 47% to 90%). 

We analyzed all large vessel occlusions treated with MT at our institution over a period of 3 years, 2 years prior to and 1 year following the implementation of anesthesiology for all MT cases. Three sets of patients were compared: those treated before versus after 24/7 anesthesia, all patients treated with CS vs all patients treated with GA over the entire period, and all right-sided strokes treated before and after 24/7 anesthesia.

A total of 378 (N= 253 pre-anesthesia, 125 post-anesthesia, 147 CS, 231 GA, 119 right-sided pre-anesthesia, 65 right-sided post-anesthesia) cases met inclusion criteria. There were significantly more patients with left-sided and severe strokes among patients who received GA (59% and 69%) compared to CS (39% and 48%). There were no differences in patients requiring > 1 pass or who achieved TICI score of 2b to 3, and no differences in length of stay, mortality at 90 days, or median mRS at 90 days.  Time to groin puncture was longer in the post-anesthesia, GA, and right-sided post-anesthesia groups, but arrival to recanalization did not differ between any groups.  ICH was more common in the right-sided (34% vs 15%) and overall post-anesthesia group (30% vs 18%), and GA group (26% vs 16%).

Anesthesia involvement and the increase in GA use was not associated with increased time to recanalization, mortality, adverse events, or longer hospital stays.