General or Local Anesthesia During Endovascular Procedures

Deciding on the type of anesthesia traditionally depends on personal preference and experience of the interventionalist. Recent evidence appears to support the shift from general (GA) to local (LA) anesthesia in neurovascular interventions. Regional anesthesia reduces the risks of major complications associated with carotid endarterectomy compared with GA,1 However, unlike elective interventions, the optimal modality of sedation during emergent endovascular procedures in the acute stroke setting has not been established.Our proponents defend 2 diametrically opposed strategies. Beckenfield et al prefer steering their boat quietly by placing the patient under GA to avoid head movements that may potentially affect safety and technical success of the procedure, providing optimal pain control and airway protection, but unaware of the impact of the intervention and hemodynamic changes on the patient’s clinical status. In contrast, Gupta does not like the darkness; he needs to control the patient’s clinical and hemodynamic status and …