Endovascular thrombectomy in acute ischemic stroke: new treatment guide

Purpose of review Recent randomized clinical trials (RCTs) have demonstrated strong efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) from large vessel occlusions (LVO). SIESTA, AnSTROKE, GOLIATH showed no deleterious effects of general anesthesia on patient outcome after EVT compared with conscious sedation. DAWN and DEFUSE 3 are extending the time window for EVT up to 24 h in carefully selected patients. This review discusses the current literature on the rapidly expanding subject of endovascular stroke therapy and optimal anesthetic management. Recent findings Recent retrospective studies of RCT data sets show that general anesthesia is associated with negative clinical outcome in AIS patients undergoing EVT when compared with sedation. Two of the possible mechanisms of this finding are systolic hypotension and hypocapnia. SIESTA, AnSTROKE, GOLIATH showed no difference in short-term clinical outcome between EVT patients treated with general anesthesia versus conscious sedation. DAWN and DEFUSE 3 demonstrated improved functional outcomes after EVT in those treated up to 24 h after selection with perfusion imaging, increasing the number of patients eligible for EVT. Summary Effective reperfusion with stent retriever technology, careful patient selection using perfusion imaging, and careful use of anesthetic technique affect outcome. Correspondence to Apolonia E. Abramowicz, MD, Department of Anesthesiology, Westchester Medical Center, New York Medical College, 100 Woods Road, Macy Pavilion Room 2391, Valhalla, NY 10595, USA. Tel: +1 914 493 7692; e-mail: elisabeth.abramowicz@gmail.com Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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