Purpose To determine the effect of general anesthesia (GA) versus conscious sedation (CS) on radiation exposure (RE), procedure time (PT), and fluoroscopy time (FT) in patients receiving endovascular stroke treatment (EST) for large vessel occlusions (LVOs) in the anterior circulation.
Methods Retrospective analysis of an institutional review board−approved prospective stroke database of a comprehensive stroke center focusing on RE (as dose area product (DAP) in Gy.cm², median (IQR)), PT, and FT (in minutes, median (IQR)) in patients receiving EST for LVOs of the anterior circulation according to the mode of anesthesia during the intervention.
Results Overall 544 patients were included in this analysis (GA: n=143, CS: n=401). For all included LVOs in the anterior circulation PTs (GA: 69 (44–100); CS: 59 (37–99); p=0.235), FTs (GA: 33 (20–56); CS: 29 (16–51); p=0.286), and RE (DAP, GA: 116.23 (73.47–173.41); CS: 110.5 (68.35–184.65); p=0.929) were comparable. In a subgroup analysis of occlusions of the middle cerebral artery (M1-segment; GA: n=80/544, 14.7%; CS: n=211/544, 38.8%), PTs (GA: 69 (37–101); CS: 54 (35 – 89); p=0.223), FTs (GA: 33 (19–55); CS: 25 (14–48); p=0.264), and RE (DAP, GA: 110.91 (66.8–169.12); CS: 103.8 (63.17–181); p=0.893) were similar.
Conclusion In this retrospective analysis, no effect of the mode of anesthesia on the radiation exposure during EST was detected as GA and CS showed comparable PT, FT, and DAPs.
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FH and CSW contributed equally.
Contributors JARP designed the study, had access to all data, supervised data collection and performed the analysis, writing, and editing of this manuscript. FH and CSW had had access to all data, performed data collection, writing and editing of this manuscript. FH and CW contributed equally to this work and have agreed to share the first authorship. MM, SS, PAR, and MB contributed to the writing and editing of this manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests PAR: reports personal fees from Boehringer Ingelheim, Bayer, BMS, Daiichi Sankyo, and Covidien, outside the submitted work. MM: unrelated: board membership: Codman; consultancy: Medtronic, MicroVention, Stryker; grants/grants pending: Balt*, MicroVention*; payment for lectures Including service on speakers bureaus: Medtronic, MicroVention, Stryker. *Money paid to the institution. MB: activities related to this article: disclosed no relevant relationships. Activities not related to this article: grants and personal fees from Bayer, Codman, Guerbet, Medtronic, and Novartis; grants from the Hopp Foundation, Siemens, and Stryker; personal fees from Braun, Böhringer Ingelheim, Roche, Teva, and Vascular Dynamics. Other relationships: disclosed no relevant relationships. JARP: activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: travel and meeting expenses from Stryker and MicroVention. Other relationships: disclosed no relevant relationships.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement N/A.
Patient consent for publication Not required.