BACKGROUND AND PURPOSE:E
ndovascular therapy for acute ischemic stroke is ofte
n performed with the patie
nt u
nder co
nscious sedatio
n. Emerge
nt co
nversio
n from co
nscious sedatio
n to ge
neral a
nesthesia is sometimes
necessary. The aim of this study was to assess the fu
nctio
nal outcome i
n co
nverted patie
nts compared with patie
nts who remai
ned i
n co
nscious sedatio
n a
nd to ide
ntify predictors associated with the risk of co
nversio
n.
MATERIALS AND METHODS:Data from 368 patie
nts, i
ncluded i
n 3 trials ra
ndomizi
ng betwee
n co
nscious sedatio
n a
nd ge
neral a
nesthesia before e
ndovascular therapy (SIESTA, ANSTROKE, a
nd GOLIATH) co
nstituted the study cohort. Twe
nty-o
ne (11%) of 185 patie
nts ra
ndomized to co
nscious sedatio
n were emerge
ntly co
nverted to ge
neral a
nesthesia.
RESULTS:Abse
nce of hyperlipidemia seemed to be the stro
ngest predictor of co
nversio
n to ge
neral a
nesthesia, albeit a weak predictor (area u
nder curve = 0.62). Sex, hyperte
nsio
n, diabetes, smoki
ng status, atrial fibrillatio
n, blood pressure, size of the i
nfarct, a
nd level a
nd side of the occlusio
n were
not sig
nifica
ntly associated with co
nversio
n to ge
neral a
nesthesia. Neither age (mea
n age, 71.3 ± 13.8 years for co
nscious sedatio
n versus 71.6 ± 12.3 years for co
nverters,
P = .58)
nor severity of stroke (mea
n NIHSS score, 17 ± 4 versus 18 ± 4, respectively,
P = .27) were sig
nifica
ntly differe
nt betwee
n co
nverters a
nd those who tolerated co
nscious sedatio
n. The co
nverters had sig
nifica
ntly worse outcome with a commo
n odds ratio of 2.67 (
P = .015) for a shift toward a higher mRS score compared with the patie
nts remai
ni
ng i
n the co
nscious sedatio
n group.
CONCLUSIONS:Patie
nts u
ndergoi
ng co
nversio
n had sig
nifica
ntly worse outcome compared with patie
nts remai
ni
ng i
n co
nscious sedatio
n. No factor was ide
ntified that predicted co
nversio
n from co
nscious sedatio
n to ge
neral a
nesthesia.
Five studies published i
n 2015 proved the efficacy of e
ndovascular therapy (EVT) for acute ischemic stroke caused by a large-vessel occlusio
n.
1 However,
numerous questio
ns remai
n regardi
ng how to best deliver this treatme
nt, i
ncludi
ng evaluatio
n of the optimal thrombectomy tech
nique,
2 the most effective method of patie
nt triage,
3 or whether EVT should be performed with the patie
nt u
nder either ge
neral a
nesthesia (GA) or co
nscious sedatio
n (CS).Observatio
nal studies have suggested that EVT with the patie
nt u
nder CS is associated with better
neurologic outcome a
nd lower mortality compared with GA.
4 However, 3 ra
ndomized trials reported similar outcomes betwee
n CS a
nd GA.
5-7 Proposed be
nefits of CS i
nclude stable hemody
namics, cli
nical mo
nitori
ng, a
nd a pote
ntially shorter procedure. The disadva
ntages are a
n u
nprotected airway a
nd patie
nt moveme
nt, which sometimes may require emerge
nt co
nversio
n to GA. Patie
nts who
need co
nversio
n might be sicker (larger strokes, more medical complicatio
ns), but the co
nversio
n procedure itself may also have a pote
ntially deleterious i
nflue
nce o
n outcome due to the emerge
nt a
nesthetic i
nductio
n, associated hypote
nsio
n, a
nd added time delay before reperfusio
n.Although most patie
nts ca
n be treated u
nder the less complex CS, it is of i
nterest to ide
ntify factors that ca
n predict the risk of co
nversio
n a
nd he
nce the requireme
nt for GA. We u
ndertook a detailed a
nalysis of the patie
nts who were co
nverted from CS to GA i
n our i
ndividual patie
nt data base from the 3 ra
ndomized trials to exami
ne the outcome of the co
nverted patie
nts compared with patie
nts who remai
ned i
n CS. We also aimed to ide
ntify possible predictors associated with a
need for GA with EVT.
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