Introduction: While three randomized trials recently showed no difference in clinical outcomes between general anesthesia and conscious sedation in stroke patients undergoing endovascular therapy (EVT) for acute ischemic stroke, preliminary data suggest that anesthesia duration itself might adversely affect stroke outcomes. Therefore, we aimed to explore the impact of general anesthesia duration on functional outcome in stroke patients undergoing EVT for large vessel occlusion (LVO).
Methods: We analyzed prospectively collected data from consecutive ischemic stroke patients who underwent EVT for LVO in the anterior circulation from 01/2016 to 06/2017. To investigate the sole effect of anesthesia, we excluded patients whose anesthesia lasted >= 72 hours (e.g., due to perceived course of malignant infarction) or was prolonged due to medical reasons (e.g., symptomatic intracranial bleeding, malignant infarction). Multivariate linear regression model adjusted for covariates was employed to evaluate whether modified Rankin Scale (mRS) scores at 3 months could be predicted by duration of anesthesia.
Results: Of 155 ischemic stroke patients undergoing EVT for LVO during the study period, 82 received general anesthesia initiated prior to or during the procedure. Of these patients, 68 fulfilled our inclusion criteria: median age 75 years (IQR, 16); 46% men; median NIHSS score 18 (6); median ASPECT score 7 (2). The median duration of general anesthesia was 440 (1015) minutes and of ventilation/intubation 590 (2150) minutes. Multivariate linear regression analysis revealed that each minute increment in general anesthesia independently predicted mRS scores at 3 months (r2=0.368, F=5.13, p<0.0001), adjusted for age, baseline NIHSS, baseline ASPECTS, intravenous tPA, onset-to-groin puncture time and complete reperfusion post-EVT.
Conclusions: Prolonged anesthesia might negatively affect functional outcome after endovascular therapy in acute ischemic stroke patients undergoing endovascular therapy for large vessel occlusion.