Local Is Better Than General Anesthesia During Endovascular Acute Stroke Interventions

The aim of endovascular reperfusion techniques for acute ischemic stroke is to improve clinical outcomes. Reperfusion grade, age, earlier time to reperfusion, and location of vessel occlusion have been implicated in impacting clinical outcome.1,2 Interestingly, much of the focus in acute stroke protocols has been in the emergency room and stroke units, but the endovascular specialist does not typically adhere to a standard medical or technical protocol. Arguably, the time spent in the endovascular suite may be the most critical portion of patient care and the medical management (ie, blood sugars, blood pressure readings, neurological assessments, etc) is likely not monitored as rigorously as in the intensive care unit. The use of general anesthesia (GA) is common for such interventions ranging from 23% to 44% in recent publications.2,3Proponents of GA have argued that the procedure is safer due to patient immobility, that hemodynamics are more tightly controlled, anesthesia may offer cerebral protection, and that the airway …