TY - JOUR T1 - General anesthesia vs procedural sedation for failed NeuroThrombectomy undergoing rescue stenting: intention to treat analysis JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg DO - 10.1136/jnis-2022-019376 SP - jnis-2022-019376 AU - Mahmoud H Mohammaden AU - Diogo C Haussen AU - Alhamza R Al-Bayati AU - Ameer E Hassan AU - Wondwossen Tekle AU - Johanna T Fifi AU - Stavros Matsoukas AU - Okkes Kuybu AU - Bradley A Gross AU - Michael Lang AU - Sandra Narayanan AU - Gustavo M Cortez AU - Ricardo A Hanel AU - Amin Aghaebrahim AU - Eric Sauvageau AU - Mudassir Farooqui AU - Santiago Ortega-Gutierrez AU - Cynthia B Zevallos AU - Milagros Galecio-Castillo AU - Sunil A Sheth AU - Michael Nahhas AU - Sergio Salazar-Marioni AU - Thanh N Nguyen AU - Mohamad Abdalkader AU - Piers Klein AU - Muhammad Hafeez AU - Peter Kan AU - Omar Tanweer AU - Ahmad Khaldi AU - Hanzhou Li AU - Mouhammad Jumaa AU - Syed F Zaidi AU - Marion Oliver AU - Mohamed M Salem AU - Jan-Karl Burkhardt AU - Bryan Pukenas AU - Rahul Kumar AU - Michael Lai AU - James E Siegler AU - Sophia Peng AU - Ali Alaraj AU - Raul G Nogueira Y1 - 2022/12/08 UR - http://jnis.bmj.com/content/early/2023/02/13/jnis-2022-019376.abstract N2 - Background There is little data available to guide optimal anesthesia management during rescue intracranial angioplasty and stenting (ICAS) for failed mechanical thrombectomy (MT). We sought to compare the procedural safety and functional outcomes of patients undergoing rescue ICAS for failed MT under general anesthesia (GA) vs non-general anesthesia (non-GA).Methods We searched the data from the Stenting and Angioplasty In Neuro Thrombectomy (SAINT) study. In our review we included patients if they had anterior circulation large vessel occlusion strokes due to intracranial internal carotid artery (ICA) or middle cerebral artery (MCA-M1/M2) segments, failed MT, and underwent rescue ICAS. The cohort was divided into two groups: GA and non-GA. We used propensity score matching to balance the two groups. The primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included functional independence (90-day mRS0-2) and successful reperfusion defined as mTICI2B-3. Safety measures included symptomatic intracranial hemorrhage (sICH) and 90-day mortality.Results Among 253 patients who underwent rescue ICAS, 156 qualified for the matching analysis at a 1:1 ratio. Baseline demographic and clinical characteristics were balanced between both groups. Non-GA patients had comparable outcomes to GA patients both in terms of the overall degree of disability (mRS ordinal shift; adjusted common odds ratio 1.29, 95% CI [0.69 to 2.43], P=0.43) and rates of functional independence (33.3% vs 28.6%, adjusted odds ratio 1.32, 95% CI [0.51 to 3.41], P=0.56) at 90 days. Likewise, there were no significant differences in rates of successful reperfusion, sICH, procedural complications or 90-day mortality among both groups.Conclusions Non-GA seems to be a safe and effective anesthesia strategy for patients undergoing rescue ICAS after failed MT. Larger prospective studies are warranted for more concrete evidence.Data are available upon reasonable request. ER -