RT Journal Article SR Electronic T1 Local anesthesia versus general anesthesia during endovascular therapy for acute stroke: a propensity score analysis JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP 207 OP 211 DO 10.1136/neurintsurg-2020-015916 VO 13 IS 3 A1 Raoul Pop A1 François Severac A1 Emmanuel Happi Ngankou A1 Oana Harsan A1 Ioan Martin A1 Dan Mihoc A1 Monica Manisor A1 Mihaela Simu A1 Salvatore Chibbaro A1 Valérie Wolff A1 Roxana Gheoca A1 Alain Meyer A1 Julien Pottecher A1 Gérard Audibert A1 Anne-Laure Derelle A1 Romain Tonnelet A1 Liang Liao A1 François Zhu A1 Serge Bracard A1 René Anxionnat A1 Sébastien Richard A1 Rémy Beaujeux A1 Benjamin Gory YR 2021 UL http://jnis.bmj.com/content/13/3/207.abstract AB Background To date, the choice of optimal anesthetic management during endovascular therapy (EVT) of acute ischemic stroke patients remains subject to debate. We aimed to compare functional outcomes and complication rates of EVT according to the first-line anesthetic management in two comprehensive stroke centers: local anesthesia (LA) versus general anesthesia (GA).Methods Retrospective analysis of prospectively collected databases, identifying all consecutive EVT for strokes in the anterior circulation performed between January 1, 2018 and December 31, 2018 in two EVT-capable stroke centers. One center performed EVT under LA in the first intention, while the other center systematically used GA. Using propensity score analysis, the two groups underwent 1:1 matching, then procedural metrics, complications, and clinical outcomes were compared. Good outcome was defined as 90 days modified Rankin Scale (mRS) ≤2, and successful recanalization as modified Thrombolysis In Cerebral Ischemia (mTICI) 2b-3.Results During the study period, 219 patients were treated in the LA center and 142 in the GA center. Using the propensity score, 97 patients from each center were matched 1:1 according to the baseline characteristics. Local anesthesia was associated with a significantly lower proportion of good outcome (36.1% vs 52.0%, OR 0.53, 95% CI 0.33 to 0.87; p=0.039), lower rate of successful recanalization (70.1% vs 95.8%, OR 0.13, 95% CI 0.04 to 0.39; p<0.001), and more procedural complications (14.4% vs 3.0%, OR 3.44, 95% CI 1.09 to 14.28; p=0.018). There were no significant differences in 90-day mortality or symptomatic hemorrhagic transformation rates.Conclusions In this study, systematic use of GA for stroke EVT was associated with better clinical outcomes, higher recanalization rates, and fewer procedural complications compared with patients treated under LA as the primary anesthetic approach.