Anesthesia for Endovascular Approaches to Acute Ischemic Stroke

Abstract

Stroke is a major cause of serious, long-term disability. The majority of stroke cases are ischemic (87%).

The initial treatment of patients with acute ischemic stroke (AIS) focuses on rapid recanalization, which often includes the use of endovascular therapies. Endovascular treatment depends upon micronavigation of catheters and devices into the cerebral vasculature, which is easier and safer with a motionless patient.

Anaesthetic management of the acute stroke patient demands consideration of the penumbra as the central focus. Anaesthetic technique (general or local) must be selected considering the individual patient's general conditions, neurologic deficits, airway and hemodynamic status, treatment plan, risks and benefits.

Unfortunately, many stroke patients are unable to communicate and sufficiently cooperate with the procedure. Thus, general anesthesia (GA) with endotracheal intubation provides an attractive means of keeping the patient comfortable and motionless during a procedure that could otherwise be lengthy and uncomfortable. However, several recent studies have shown an association between GA and poorer outcomes in comparison with

local anaesthesia for endovascular treatment of AIS. Although baseline condition of the patients in these studies differed . The worse outcomes with GA may be due to hemodynamic instability and hypotension, delays in treatment or prolonged intubation with or without neuromuscular blockade.