Anesthetic Management in Endovascular Stroke Therapy

Anesthetic management during endovascular stroke therapy is pivotal in optimising neurological outcome and minimising procedure-related complications. The choice between general anaesthesia and conscious sedation hinges on a balance between procedural safety and preservation of cerebral perfusion. General anaesthesia affords immobility and airway protection but may incur periods of hypotension and delays in reperfusion. Conscious sedation permits neurological monitoring, reduces intubation-related risks and often expedites procedural onset, yet may be challenged by patient movement and airway compromise. Central to intra-procedural care is maintenance of haemodynamic stability, with careful titration of vasoactive agents to support cerebral perfusion pressure while avoiding hypertension that could precipitate haemorrhagic transformation. Blood pressure targets are generally tailored to mitigate hypotensive episodes, particularly in the pre-reperfusion phase, where optimal systolic and mean arterial pressure thresholds remain under active investigation. Timely extubation and minimisation of ventilation duration have also emerged as strategies to reduce pneumonia risk and promote functional recovery. A nuanced approach, integrating patient comorbidities, vessel occlusion characteristics and centre expertise, is paramount to achieving improved functional independence and reduced mortality in acute ischaemic stroke.

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Anesthetic Management in Endovascular Stroke Therapy publication trend

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Technical terms

Endovascular thrombectomy: mechanical retrieval of a thrombus via catheter access to restore cerebral blood flow.

General anaesthesia: a medically induced, reversible state of unconsciousness with loss of protective reflexes requiring airway support.

Conscious sedation: a sedation technique preserving patient responsiveness and airway control during procedures.

Mean arterial pressure (MAP): the time-weighted average arterial blood pressure, reflecting perfusion pressure to vital organs.

Modified Rankin Scale (mRS): a six-point scale measuring degree of disability or dependence in daily activities after stroke.

References

1. Clinical outcome after endovascular stroke Thrombectomy: Association with pre-reperfusion blood pressure. Journal of Clinical Anesthesia (2024).
2. Even Small Decreases in Blood Pressure during Conscious Sedation Affect Clinical Outcome after Stroke Thrombectomy: An Analysis of Hemodynamic Thresholds. American Journal of Neuroradiology (2016).
3. Effect of Conscious Sedation vs. General Anesthesia on Outcomes in Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke: A Prospective Randomized Clinical Trial. Frontiers in Neurology (2020).
4. Clinical Impact of Ventilation Duration in Patients with Stroke Undergoing Interventional Treatment under General Anesthesia: The Shorter the Better?. American Journal of Neuroradiology (2016).