The impact of general anesthesia versus non-general anesthesia on thrombectomy outcomes by occlusion location: insights from the ETIS registry

Mohammad Anadani; Benjamin Gory; Jean-Marc Olivot; Romain Bourcier; Arturo Consoli; Grégoire Boulouis; Kevin Janot; Raoul Pop; Jean-Philippe Desilles; Lina Hamoud; Mikael Mazighi; Bertrand Lapergue; Gaultier Marnat; Stefanos Finitsis; List of ETIS Investigators

doi:10.3171/2024.5.JNS24199

The impact of general anesthesia versus non-general anesthesia on thrombectomy outcomes by occlusion location: insights from the ETIS registry

J Neurosurg. 2024 Aug 23:1-9. doi: 10.3171/2024.5.JNS24199. Online ahead of print.

Authors

Collaborators

List of ETIS Investigators:
Bertrand Lapergue, Adrien Wang, Arturo Consoli, Oguzhan Coskun, Federico Di Maria, Silvia Pizzuto, Alessandro Sgreccia, Charline Benoit, Lucas Gorza, David Weisenburger-Lile, Waliyde Jabeur, Tchikviladze Maia, Serge Evrard, Georges Rodesch, Raphaël Blanc, Michel Obadia, Jean-Philippe Desilles, Michel Piotin, Pierre Seners, Stanislas Smajda, Simon Escalard, Benjamin Maier, Candice Sabben, Hocine Redjem, Mikael Mazhigi, Grace Adwane, François Delvoye, Amira Al Raaisi Isseau, Altayeb Adnan, Malayer Thomas, Robichon Erwan, Romain Bourcier, Benjamin Daumas Duport, Pierre Louis Alexandre, Cédric Lenoble, Hubert Desal, Solene De Gaalon, Benoît Guillon, Cécile Preterre, Guillaume Tessier, Arthur Lionnet, Benjamin Gory, Lisa Humbertjean-Selton, René Anxionnat, Anne-Laure Derelle, Liang Liao, Emmanuelle Schmitt, Sophie Planel, Sébastien Richard, Gioia Mione, Jean-Christophe Lacour, Marian Douarinou, Emilien Micard, Bailiang Chen, Gérard Audibert, Agnès Masson, Lionel Alb, Marine Beaumont, Adriana Tabarna, Marcela Voicu, Grégoire Barthel, Iona Podar, Madalina Brezeanu, Marie Reitter, François Zhu, Anxionnat René, Gaultier Marnat, Jean-Sébastien Liegey, Pierre Briau, Lisa Papillon, Igor Sibon, Xavier Barreau, Jean Papaxanthos, Jérome Berge, Sabrina Debruxelles, Stéphane Olindo, Mathilde Poli, Pauline Renou, Sharmila Sagnier, Thomas Tourdias, Thomas Courret, Ludovic Lucas, Malgorzata Milnerowicz, Cyril Dargazanli, Vincent Costalat, Isabelle Mourand, Caroline Arquizan, Lucas Corti, Adrien Ter Schiphorst, Cagnazzo Federico, Imad Derraz, Mehdi Mahmoudi, Pierre-Henri Lefevre, Grégory Gascou, Quentin Varnier, Laurent Spelle, Jildaz Caroff, Christian Denier, Vanessa Chalumeau, Cristian Mihalea, Nicolas Legris, Augustin Ozanne, Leon Ikka, Olivier Chassin, Sophie Gallas, Laura Venditti, Mariana Sarov, Jonathan Cortese, Jean-Christophe Ferre, Stephane Vannier, Thomas Ronziere, Maria Veronica Lassalle, Jean-Yves Gauvrit, Clement Tracol, Abdelghani Fakhreddine Boustia, Cecile Malrain, Edouard Beaufreton, Thibault Lapotre, Quentin Alias, Julien Hissier, Maud Guillen, François Eugene, Boucherit Julien, Cyril Chivot, Audrey Courselle, Elisa Ouin, Chantal Lamy, Kevin Delaforge, Manuel Fernandez, Jeremie Vial, Quentin Laferte, Xavier Desdoit, Serge Timsit, Aurore Jourdain, Jean-Christophe Gentric, Julien Ognard, Irina Viakhireva, Jordan Coris, Sabine Prud'hon, François-Mathias Merrien, Denis Marechal, Marie Bruguet, Pierre Yves Rousseau, Philippe Goas, Elise Retho, Caroline Lavenant, Rozenn Le Gal, Leblanc Amelie, Marion Boulanger, Emmanuel Touze, Denis Vivien, Charlotte Barbier, Romain Schneckenburger, Fabrizio Salaris, Julien Cogez, Sophie Guettier, Estelle La Porte, Jean Bouchart, Charbel Mounayer, Aymeric Rouchaud, Suzana Saleme, Géraud Forestier, Frédéric Clarencon, Charlotte Rosso, Sara Leder, Flore Baronnet, Sophie Crozier, Anne Leger, Kevin Premat, Shotar Eimad, Stéphanie Lenck, Nader Sourour, Laure Bottin, Sam Ghazanfari, Marion Yger, Sonia Alamowitch, Stephen Delorme, Aymeric Wittwer, Christine Vassilev, Allard Julien, Olivier Naggara, Guillaume Turc, Wagih Ben Hassen, Basile Kerleroux, Denis Trystram, Christine Rodriguez-Regent, Finoana Laza-Nomenjanahary, Ozlem Ozkul-Wermester, Chrysanthi Papagiannaki, Evelyne Massardier, Aude Triquenot, Margaux Lefebvre, Julien Burel, Basille Florient, Alain Viguier, Christophe Cognard, Anne Christine Januel, Jean-François Albucher, Lionel Calviere, Jean-Marc Olivot, Jean Darcourt, Nicolas Raposo, Fabrice Bonneville, Guillaume Bellanger, Louis Fontaine, Philippe Tall, Frédéric Bourdain, Patricia Bernady, Guillaume Ballan, Stephanie Bannier, Emmanuel Ellie, Olivier Flabeau, Julia Potenza, Antoine Soulages, Laurent Lagoarde-Segot, Hélène Cailliez, Louis Veunac, David Higue, Anthony Lebras, Sarah Adam, Benoit Pegat, Arnaud Le Guen, François Chedeville, Jérémy Jouan, Allibert Rémi, Alexanre Courtois, Sarah Evain, Lescot Lucile, Stéphanie Demasles, Johann Sebastian Richter, Bruno Thierry Barroso, Camille Dahan, Alexis Gonnet, Régis Hubrecht, Zoé Lepine, Hélène Castagnet, Raluca Marasescu, Olivier Heck, Pauline Cuisenier, Olivier Detante, Isabelle Favre Wiki, Clémentine Bonaz, Garambois Katia, Loic Legris, Adrian Kastler, Kamel Boubagra, Corentin Berthet, Stéphane Charara, Victor Dumas, Neau Jean Philippe, Velasco Stéphane, Valérie Wolff, Raoul Pop, Véronique Quenardelle, Valérie Lauer, Irène Pierre-Paul, Roxana Gheoca, Malwina Trzeciak, Bindila Perisse Daniella, Bonnart Camille, Solène Moulin, Hua Vi Tuan, Paolo Pagano, Alexandre Doucet, Christophe Gelmini, Pierre-François Manceau, Laurentiu Pajusan, Isabelle Serre, Sébastien Soize, Thi Ngoc Phuong Nguyen, Maher Sahnoun, Nathalie Caucheteux, Pablo Lebindsky, Nader Vanessa, Federico Bolignini, Francis Vuillemet, José Rodregues, Anna Ferrier, Abderrahim Zerroug, Ricardo Moreno, Emmanuel Chabert, Elie Lteif, Pauline Paris, Nathalie Bourgois, Marie Raquin, Anne Pasco-Papon, Jean Baptiste Girot, Alderic Lecluse, Sophie Godard, Vincent L'Allinec, Corfu Alice, Kevin Janot, Richard Bibi, Marie Gaudron, Arnaud Bretonniere, Mariam Annan, Héloïse Ifergan, Grégoire Boulouis, Marco Pasi, Séverine Debiais, Elisabeth Molinier, Denis Herbretau, Romain Doung, Fouzi Bala, Clemencie Hoche, Anthony Wietrich, Valérie Ruche, Karine Lavandier, Yannick Bejot, Brivale Lemogne, Fédéric Ricolfi, Laura Baptiste, Pierre Thouant, Gaulthier Duloquin, Pierre Olivier Comby, Guillaume Charbonnier, Louise Bonnet, Nicolas Raybaud, Benjamin Bouamra, Thierry Moulin, Alessandra Biondi, Pico Fernando, Dano Benjamin, Patcas Carmen, Chaari Dhouha, Stanciu Daniela, Duang Duc Long, Hmida Intissar, Marie-Laure Chadenat, Suissa Laurent, Doche Emilie, Hak Jean-François, Reyre Anthony, Carle Xavier, Laksiri Nadia, Osman Ophélie, Peres Roxane, Robinet-Borgomano Emmanuelle, Dulau Cécile, Kerleroux Basile, Rey Caroline, Basile Kerleroux, Jérôme Berge, Fabrice Bing

Affiliations

¹ 1Department of Neuroscience, Intent Medical Group, Endeavor Health, Arlington Heights, Illinois.
² 2Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, INSERM U1254, Nancy, France.
³ 3Department of Neurology, CHU Toulouse, France.
⁴ 4Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, France.
⁵ 5Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Versailles, France.
⁶ 6Department of Neuroradiology, Tours University Hospital, Tours, France.
⁷ 7Interventional Neuroradiology, University Hospitals Strasbourg, France.
⁸ 8Department of Interventional Neuroradiology, Fondation Ophtalmologique A. De Rothschild, Paris, France.
⁹ 9Department of Healthcare administration, Northwestern University, Chicago, Illinois.
¹⁰ 10Department of Neurology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, Versailles, France.
¹¹ 11Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, France; and.
¹² 12Aristotle University of Thessaloniki, Ahepa Hospital, Thessaloniki, Greece.

PMID: 39178480
DOI: 10.3171/2024.5.JNS24199

Abstract

Objective: Identifying the optimal anesthetic technique for mechanical thrombectomy (MT) remains an unresolved issue. Prior research has not considered the influence of occlusion site when comparing general anesthesia (GA) with non-GA. This study evaluates the differential impacts of the anesthetic technique (GA vs non-GA) on outcomes according to the location of occlusion.

Methods: This is a retrospective analysis of the ETIS (Endovascular Treatment in Ischemic Stroke) registry. Patients with anterior circulation large-vessel occlusion treated with MT were included. Patients were divided into groups according to the location of occlusion. Inverse propensity score weighting analysis was used.

Results: Among 2783 patients included in the propensity score analysis, 669 (24%) received GA. In the total cohort, GA was not associated with favorable outcome, excellent outcome, successful reperfusion, or complete reperfusion. GA was associated with higher odds of parenchymal hemorrhage (OR 1.42, 95% 1.05-1.92) but not symptomatic intracranial hemorrhage. GA was associated with Alberta Stroke Program Early CT Score progression (OR 1.36, 95% CI 1.11-1.68). In the internal carotid artery occlusion group, GA was associated with higher odds of mortality (OR 1.94, 95% CI 1.15-3.27). In the M1 group, GA was associated with lower odds of complications (OR 0.41, 95% CI 0.19-0.92). In the M2 group, GA was associated with successful reperfusion (OR 2.79, 95% CI 1.02-7.64). In addition, the complication rate was lower with GA (2.7% vs 7%), although the association was not significant in adjusted analysis.

Conclusions: While GA and non-GA techniques did not differ significantly in functional outcomes, the influence of GA on angiographic and procedural safety outcomes was location dependent, underscoring the importance of a tailored anesthesia technique in MT procedures.

Keywords: anesthesia; endovascular neurosurgery; sedation; stroke; thrombectomy.