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  • The continuous quest for a more tailored approach to anesthetic management of patients undergoing endovascular therapy for acute stroke

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Letter to the editor
The continuous quest for a more tailored approach to anesthetic management of patients undergoing endovascular therapy for acute stroke
  1. Mario Ganau1,2,
  2. Davide Simonato3,
  3. Nikolaos Syrmos4,
  4. Santino O Tomasi2,
  5. Peter A Winkler2,
  6. Lara Prisco5
  1. 1 Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2 Department of Neurosurgery, Paracelsus Medical University Salzburg, Salzburg, Austria
  3. 3 Interventional Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  4. 4 School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece
  5. 5 Anaesthesia & NeuroIntensive Care, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  1. Correspondence to Mario Ganau, Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK; Mario.Ganau{at}alumni.harvard.edu

https://doi.org/10.1136/neurintsurg-2020-016512

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    To the Editor

    We read with great interest the article by Pop et al 1 on a propensity score analysis comparing anesthetic management of patients undergoing endovascular therapy for acute stroke. The greatest strength of their article lies in the wise choice of this statistical approach to answer the research question regarding ‘the outcome of stroke mechanical thrombectomy (MT) under local anesthesia (LA)’. Pop et al present a retrospective analysis of prospectively collected endovascular procedure databases of stroke interventions performed in 2018 in two different institutions, Strasbourg and Nancy, adopting two different first-line anesthetic protocols: LA versus general anesthesia (GA) during MT. In doing so, the authors are to be commended for they successfully stayed true to the intention of ‘comparing two anesthetic strategies, and not just different anesthetic methods’ in a real life setting, outside of the strict boundaries of a randomized controlled trial.

    Pop et al extensively discussed the potential reasons why the use of systematic GA compared with LA was surprisingly associated in their analysis with better 90 day clinical outcome, higher recanalization rates, and fewer procedural complications. However, given …

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    Footnotes

    • Contributors MG: conception and design of the letter. MG, LP: statistical analysis and drafting the manuscript. All authors: analysis and interpretation of data, critical review of the literature, final approval of the submission

    • 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 None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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