SIESTA: Thrombectomy as you like

Excerpt

Thrombectomy has become the treatment of choice for stroke due to large vessel occlusion; however, there has been a lot of debate on the mode of patient management during thrombectomy. Recent retrospective data suggested a worse outcome in patients undergoing general anesthesia when compared to conscious sedation only [1]; however, these data have been criticized due to a potentially severe selection bias. A post hoc analysis of the MR CLEAN trial also indicated a more favorable outcome in patients not undergoing general anesthesia [2] but all of these studies compared either different patients or centers. These effects may have been much stronger than the mode of patient management during the intervention; therefore, a single center randomized controlled trial Sedation vs. Intubation for Endovascular Stroke Treatment (SIESTA) was conducted to compare general anesthesia and conscious sedation in patients with large vessel occlusion [3]. All patients were treated by an experienced team of neurointerventionalists and stroke specialists, and randomization was performed prior to treatment. Primary outcome, i. e. early neurological improvement in the NIHSS after 24 h, was not significantly different between the general anesthesia group vs. the conscious sedation group. In the general anesthesia vs. the conscious sedation group, substantial patient movement was less frequent, but postinterventional complications were more frequent for hypothermia, delayed extubation, and pneumonia. More patients were functionally independent (unadjusted mRS score 0–2 after 3 months in 37.0% of the general anesthesia group vs. 18.2% of the conscious sedation group, P = 0.01). There were no differences in mortality at 3 months (24.7% in both groups). The authors concluded that the study findings do not support an advantage for the use of conscious sedation. …