• Mohammad Anadani, Benjamin Gory, Jean-Marc Olivot, Romain Bourcier, Arturo Consoli, Grégoire Boulouis, Kevin Janot, Raoul Pop, Jean-Philippe Desilles, Lina Hamoud, Mikael Mazighi, Bertrand Lapergue, Gaultier Marnat, Stefanos Finitsis, and List of ETIS Investigators.
• 1Department of Neuroscience, Intent Medical Group, Endeavor Health, Arlington Heights, Illinois.
• J. Neurosurg. 2024 Aug 23: 191-9.

ObjectiveIdentifying the optimal anesthetic technique for mechanical thrombectomy (MT) remains an unresolved issue. Prior research has not considered the influence of occlusion site when comparing general anesthesia (GA) with non-GA. This study evaluates the differential impacts of the anesthetic technique (GA vs non-GA) on outcomes according to the location of occlusion.MethodsThis is a retrospective analysis of the ETIS (Endovascular Treatment in Ischemic Stroke) registry. Patients with anterior circulation large-vessel occlusion treated with MT were included. Patients were divided into groups according to the location of occlusion. Inverse propensity score weighting analysis was used.ResultsAmong 2783 patients included in the propensity score analysis, 669 (24%) received GA. In the total cohort, GA was not associated with favorable outcome, excellent outcome, successful reperfusion, or complete reperfusion. GA was associated with higher odds of parenchymal hemorrhage (OR 1.42, 95% 1.05-1.92) but not symptomatic intracranial hemorrhage. GA was associated with Alberta Stroke Program Early CT Score progression (OR 1.36, 95% CI 1.11-1.68). In the internal carotid artery occlusion group, GA was associated with higher odds of mortality (OR 1.94, 95% CI 1.15-3.27). In the M1 group, GA was associated with lower odds of complications (OR 0.41, 95% CI 0.19-0.92). In the M2 group, GA was associated with successful reperfusion (OR 2.79, 95% CI 1.02-7.64). In addition, the complication rate was lower with GA (2.7% vs 7%), although the association was not significant in adjusted analysis.ConclusionsWhile GA and non-GA techniques did not differ significantly in functional outcomes, the influence of GA on angiographic and procedural safety outcomes was location dependent, underscoring the importance of a tailored anesthesia technique in MT procedures.

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