Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery.

Meyer, Lukas; Stracke, Christian Paul; Broocks, Gabriel; Wallocha, Marta; Elsharkawy, Mohamed; Sporns, Peter B; Piechowiak, Eike I; Kaesmacher, Johannes; Maegerlein, Christian; Hernandez Petzsche, Moritz Roman; Zimmermann, Hanna; Naziri, Weis; Abdullayev, Nuran; Kabbasch, Christoph; Behme, Daniel; Thormann, Maximilian; Maus, Volker; Fischer, Sebastian; Möhlenbruch, Markus A; Weyland, Charlotte Sabine; ... (2024). Effect of anesthetic strategies on distal stroke thrombectomy in the anterior and posterior cerebral artery. Journal of neurointerventional surgery, 16(3), pp. 230-236. BMJ Publishing Group 10.1136/jnis-2023-020210

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Numerous questions regarding procedural details of distal stroke thrombectomy remain unanswered. This study assesses the effect of anesthetic strategies on procedural, clinical and safety outcomes following thrombectomy for distal medium vessel occlusions (DMVOs).


Patients with isolated DMVO stroke from the TOPMOST registry were analyzed with regard to anesthetic strategies (ie, conscious sedation (CS), local (LA) or general anesthesia (GA)). Occlusions were in the P2/P3 or A2-A4 segments of the posterior and anterior cerebral arteries (PCA and ACA), respectively. The primary endpoint was the rate of complete reperfusion (modified Thrombolysis in Cerebral Infarction score 3) and the secondary endpoint was the rate of modified Rankin Scale score 0-1. Safety endpoints were the occurrence of symptomatic intracranial hemorrhage and mortality.


Overall, 233 patients were included. The median age was 75 years (range 64-82), 50.6% (n=118) were female, and the baseline National Institutes of Health Stroke Scale score was 8 (IQR 4-12). DMVOs were in the PCA in 59.7% (n=139) and in the ACA in 40.3% (n=94). Thrombectomy was performed under LA±CS (51.1%, n=119) and GA (48.9%, n=114). Complete reperfusion was reached in 73.9% (n=88) and 71.9% (n=82) in the LA±CS and GA groups, respectively (P=0.729). In subgroup analysis, thrombectomy for ACA DMVO favored GA over LA±CS (aOR 3.07, 95% CI 1.24 to 7.57, P=0.015). Rates of secondary and safety outcomes were similar in the LA±CS and GA groups.


LA±CS compared with GA resulted in similar reperfusion rates after thrombectomy for DMVO stroke of the ACA and PCA. GA may facilitate achieving complete reperfusion in DMVO stroke of the ACA. Safety and functional long-term outcomes were comparable in both groups.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Piechowiak, Eike Immo, Kaesmacher, Johannes


600 Technology > 610 Medicine & health




BMJ Publishing Group




Pubmed Import

Date Deposited:

08 May 2023 15:06

Last Modified:

14 Feb 2024 00:11

Publisher DOI:


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Uncontrolled Keywords:

stroke thrombectomy thrombolysis





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