• Alex Abou-Chebl, Sharon D Yeatts, Bernard Yan, Kevin Cockroft, Mayank Goyal, Tudor Jovin, Pooja Khatri, Phillip Meyers, Judith Spilker, Rebecca Sugg, Katja E Wartenberg, Tom Tomsick, Joe Broderick, and Michael D Hill.
• From Baptist Neuroscience Associates, Baptist Health, Louisville, KY (A.A.-C.); Department of Public Health Sciences, Medical University of South Carolina, Charleston (S.D.Y.); Department of Neurology, Royal Melbourne Hospital, Parkville, Australia (B.Y.); Departments of Neurosurgery, Radiology, and Public Health Sciences, Penn State Hershey, PA (K.C.); Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada (M.G.); Department of Neurology, University of Pittsburgh Medical Center, PA (T.J.); Department of Neurology (P.K., J.S., J.B.) and Department of Radiology (T.T.), University of Cincinnati, OH; Departments of Radiology and Neurological Surgery, Columbia University, New York, NY (P.M.); Department of Neurology, University of Mississippi, Jackson (R.S.); Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany (K.E.W.); and Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (M.D.H.). achebl@yahoo.com.
• Stroke. 2015 Aug 1; 46 (8): 2142-8.

Background And PurposeGeneral anesthesia (GA) for endovascular therapy (EVT) of acute ischemic stroke may be associated with worse outcomes.MethodsThe Interventional Management of Stroke III trial randomized patients within 3 hours of acute ischemic stroke onset to intravenous tissue-type plasminogen activator±EVT. GA use within 7 hours of stroke onset was recorded per protocol. Good outcome was defined as 90-day modified Rankin Scale ≤2. A multivariable analysis adjusting for dichotomized National Institutes of Health Stroke Scale (NIHSS; 8-19 versus ≥20), age, and time from onset to groin puncture was performed.ResultsFour hundred thirty-four patients were randomized to EVT, 269 (62%) were treated under local anesthesia and 147 (33.9%) under GA; 18 (4%) were undetermined. The 2 groups were comparable except for median baseline NIHSS (16 local anesthesia versus 18 GA; P<0.0001). The GA group was less likely to achieve a good outcome (adjusted relative risk, 0.68; confidence interval, 0.52-0.90; P=0.0056) and had increased in-hospital mortality (adjusted relative risk, 2.84; confidence interval, 1.65-4.91; P=0.0002). Those with medically indicated GA had worse outcomes (adjusted relative risk, 0.49; confidence interval, 0.30-0.81; P=0.005) and increased mortality (relative risk, 3.93; confidence interval, 2.18-7.10; P<0.0001) with a trend for higher mortality with routine GA. There was no significant difference in the adjusted risks of subarachnoid hemorrhage (P=0.32) or symptomatic intracerebral hemorrhage (P=0.37).ConclusionsGA was associated with worse neurological outcomes and increased mortality in the EVT arm; this was primarily true among patients with medical indications for GA. Relative risk estimates, though not statistically significant, suggest reduced risk for subarachnoid hemorrhage and symptomatic intracerebral hemorrhage under local anesthesia. Although the reasons for these associations are not clear, these data support the use of local anesthesia when possible during EVT.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00359424.© 2015 American Heart Association, Inc.

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