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<meta name="DC.Title" content="Emergency Conversion to General Anesthesia Is a Tolerable Risk in Patients Undergoing Mechanical Thrombectomy" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6321" />
<meta name="DC.Date" content="2020-01-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2020 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Mechanical thrombectomy for acute ischemic stroke is performed with the patient under local anesthesia, conscious sedation, or general anesthesia. According to recent trials, up to 16% of patients require emergency conversion to general anesthesia during mechanical thrombectomy. This study investigated the procedural and clinical outcomes after emergency conversion in comparison with local anesthesia, conscious sedation, and general anesthesia.

MATERIALS AND METHODS: This retrospective study included 254 patients undergoing mechanical thrombectomy for acute large-vessel occlusion. The procedure was started with the patient either under local anesthesia, conscious sedation, or general anesthesia. Emergency conversion was defined as induction of general anesthesia during mechanical thrombectomy. The primary outcomes were successful reperfusion (TICI 2b/3) and functional independence (mRS at 90 days, ≤2).

RESULTS: Twenty-five patients (9.8%) required emergency conversion to general anesthesia. The time from admission to flow restoration was increased under general anesthesia (median, 137 minutes) and emergency conversion (median, 138 minutes) compared with local anesthesia (median 110 minutes). After adjustment for confounders, emergency conversion to general anesthesia and primary general anesthesia had comparable chances of successful reperfusion (OR = 1.28; 95% CI, 0.31–5.25). Patients with emergency conversion had a tendency toward higher chances of functional independence (OR = 4.48; 95% CI, 0.49–40.86) compared with primary general anesthesia, but not compared with local anesthesia (OR = 0.86; 95% CI, 0.14–5.11) and conscious sedation (OR = 1.07; 95% CI, 0.17–6.53).

CONCLUSIONS: Patients with emergency conversion did not have lower chances of successful reperfusion or functional independence compared those with primary general anesthesia, and time to flow restoration was also similar. We found no evidence supporting the primary induction of general anesthesia in patients at risk for emergency conversion.

CS
:   conscious sedation
GA
:   general anesthesia
MAP
:   mean arterial pressure" />
<meta name="DC.Contributor" content="F. Flottmann" />
<meta name="DC.Contributor" content="H. Leischner" />
<meta name="DC.Contributor" content="G. Broocks" />
<meta name="DC.Contributor" content="T.D. Faizy" />
<meta name="DC.Contributor" content="A. Aigner" />
<meta name="DC.Contributor" content="M. Deb-Chatterji" />
<meta name="DC.Contributor" content="G. Thomalla" />
<meta name="DC.Contributor" content="J. Krauel" />
<meta name="DC.Contributor" content="M. Issleib" />
<meta name="DC.Contributor" content="J. Fiehler" />
<meta name="DC.Contributor" content="C. Brekenfeld" />
<meta name="article:published_time" content="2020-01-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Emergency Conversion to General Anesthesia Is a Tolerable Risk in Patients Undergoing Mechanical Thrombectomy" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Mechanical thrombectomy for acute ischemic stroke is performed with the patient under local anesthesia, conscious sedation, or general anesthesia. According to recent trials, up to 16% of patients require emergency conversion to general anesthesia during mechanical thrombectomy. This study investigated the procedural and clinical outcomes after emergency conversion in comparison with local anesthesia, conscious sedation, and general anesthesia.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;This retrospective study included 254 patients undergoing mechanical thrombectomy for acute large-vessel occlusion. The procedure was started with the patient either under local anesthesia, conscious sedation, or general anesthesia. Emergency conversion was defined as induction of general anesthesia during mechanical thrombectomy. The primary outcomes were successful reperfusion (TICI 2b/3) and functional independence (mRS at 90 days, ≤2).&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Twenty-five patients (9.8%) required emergency conversion to general anesthesia. The time from admission to flow restoration was increased under general anesthesia (median, 137 minutes) and emergency conversion (median, 138 minutes) compared with local anesthesia (median 110 minutes). After adjustment for confounders, emergency conversion to general anesthesia and primary general anesthesia had comparable chances of successful reperfusion (OR = 1.28; 95% CI, 0.31–5.25). Patients with emergency conversion had a tendency toward higher chances of functional independence (OR = 4.48; 95% CI, 0.49–40.86) compared with primary general anesthesia, but not compared with local anesthesia (OR = 0.86; 95% CI, 0.14–5.11) and conscious sedation (OR = 1.07; 95% CI, 0.17–6.53).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Patients with emergency conversion did not have lower chances of successful reperfusion or functional independence compared those with primary general anesthesia, and time to flow restoration was also similar. We found no evidence supporting the primary induction of general anesthesia in patients at risk for emergency conversion.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_author" content="F. Flottmann" />
<meta name="citation_author_institution" content="aFrom the Department of Diagnostic and Interventional Neuroradiology (F.F., H.L., G.B., T.D.F., J.F., C.B.)" />
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<meta name="citation_author" content="H. Leischner" />
<meta name="citation_author_institution" content="aFrom the Department of Diagnostic and Interventional Neuroradiology (F.F., H.L., G.B., T.D.F., J.F., C.B.)" />
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<meta name="citation_author" content="G. Broocks" />
<meta name="citation_author_institution" content="aFrom the Department of Diagnostic and Interventional Neuroradiology (F.F., H.L., G.B., T.D.F., J.F., C.B.)" />
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<meta name="twitter:title" content="Emergency Conversion to General Anesthesia Is a Tolerable Risk in Patients Undergoing Mechanical Thrombectomy" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Mechanical thrombectomy for acute ischemic stroke is performed with the patient under local anesthesia, conscious sedation, or general anesthesia. According to recent trials, up to 16% of patients require emergency conversion to general anesthesia during mechanical thrombectomy. This study investigated the procedural and clinical outcomes after emergency conversion in comparison with local anesthesia, conscious sedation, and general anesthesia.

MATERIALS AND METHODS: This retrospective study included 254 patients undergoing mechanical thrombectomy for acute large-vessel occlusion. The procedure was started with the patient either under local anesthesia, conscious sedation, or general anesthesia. Emergency conversion was defined as induction of general anesthesia during mechanical thrombectomy. The primary outcomes were successful reperfusion (TICI 2b/3) and functional independence (mRS at 90 days, ≤2).

RESULTS: Twenty-five patients (9.8%) required emergency conversion to general anesthesia. The time from admission to flow restoration was increased under general anesthesia (median, 137 minutes) and emergency conversion (median, 138 minutes) compared with local anesthesia (median 110 minutes). After adjustment for confounders, emergency conversion to general anesthesia and primary general anesthesia had comparable chances of successful reperfusion (OR = 1.28; 95% CI, 0.31–5.25). Patients with emergency conversion had a tendency toward higher chances of functional independence (OR = 4.48; 95% CI, 0.49–40.86) compared with primary general anesthesia, but not compared with local anesthesia (OR = 0.86; 95% CI, 0.14–5.11) and conscious sedation (OR = 1.07; 95% CI, 0.17–6.53).

CONCLUSIONS: Patients with emergency conversion did not have lower chances of successful reperfusion or functional independence compared those with primary general anesthesia, and time to flow restoration was also similar. We found no evidence supporting the primary induction of general anesthesia in patients at risk for emergency conversion.

CS
:   conscious sedation
GA
:   general anesthesia
MAP
:   mean arterial pressure" />
<meta name="og-title" property="og:title" content="Emergency Conversion to General Anesthesia Is a Tolerable Risk in Patients Undergoing Mechanical Thrombectomy" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/41/1/122" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Mechanical thrombectomy for acute ischemic stroke is performed with the patient under local anesthesia, conscious sedation, or general anesthesia. According to recent trials, up to 16% of patients require emergency conversion to general anesthesia during mechanical thrombectomy. This study investigated the procedural and clinical outcomes after emergency conversion in comparison with local anesthesia, conscious sedation, and general anesthesia.

MATERIALS AND METHODS: This retrospective study included 254 patients undergoing mechanical thrombectomy for acute large-vessel occlusion. The procedure was started with the patient either under local anesthesia, conscious sedation, or general anesthesia. Emergency conversion was defined as induction of general anesthesia during mechanical thrombectomy. The primary outcomes were successful reperfusion (TICI 2b/3) and functional independence (mRS at 90 days, ≤2).

RESULTS: Twenty-five patients (9.8%) required emergency conversion to general anesthesia. The time from admission to flow restoration was increased under general anesthesia (median, 137 minutes) and emergency conversion (median, 138 minutes) compared with local anesthesia (median 110 minutes). After adjustment for confounders, emergency conversion to general anesthesia and primary general anesthesia had comparable chances of successful reperfusion (OR = 1.28; 95% CI, 0.31–5.25). Patients with emergency conversion had a tendency toward higher chances of functional independence (OR = 4.48; 95% CI, 0.49–40.86) compared with primary general anesthesia, but not compared with local anesthesia (OR = 0.86; 95% CI, 0.14–5.11) and conscious sedation (OR = 1.07; 95% CI, 0.17–6.53).

CONCLUSIONS: Patients with emergency conversion did not have lower chances of successful reperfusion or functional independence compared those with primary general anesthesia, and time to flow restoration was also similar. We found no evidence supporting the primary induction of general anesthesia in patients at risk for emergency conversion.

CS
:   conscious sedation
GA
:   general anesthesia
MAP
:   mean arterial pressure" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node72445--5" data-node-nid="72445" id="top-node-72445--61124863315" data-pisa="ajnr;41/1/122" data-pisa-master="ajnr;ajnr.A6321" data-apath="/ajnr/41/1/122.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Interventional</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Emergency Conversion to General Anesthesia Is a Tolerable Risk in Patients Undergoing Mechanical Thrombectomy</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">F. Flottmann</span>, <span class="highwire-citation-author" data-delta="1">H. Leischner</span>, <span class="highwire-citation-author" data-delta="2">G. Broocks</span>, <span class="highwire-citation-author" data-delta="3">T.D. Faizy</span>, <span class="highwire-citation-author" data-delta="4">A. Aigner</span>, <span class="highwire-citation-author" data-delta="5">M. Deb-Chatterji</span>, <span class="highwire-citation-author" data-delta="6">G. Thomalla</span>, <span class="highwire-citation-author" data-delta="7">J. Krauel</span>, <span class="highwire-citation-author" data-delta="8">M. Issleib</span>, <span class="highwire-citation-author" data-delta="9">J. Fiehler</span> and <span class="highwire-citation-author" data-delta="10">C. Brekenfeld</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">January 2020,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">122-127; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6321 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-72445--61124863315" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">F. Flottmann </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Diagnostic and Interventional Neuroradiology (F.F., H.L., G.B., T.D.F., J.F., C.B.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.%2BFlottmann%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Flottmann%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AF.%2BFlottmann%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8358-8089" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F. Flottmann</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">H. Leischner </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Diagnostic and Interventional Neuroradiology (F.F., H.L., G.B., T.D.F., J.F., C.B.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.%2BLeischner%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Leischner%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AH.%2BLeischner%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-6786-6341" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for H. Leischner</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">G. Broocks </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Diagnostic and Interventional Neuroradiology (F.F., H.L., G.B., T.D.F., J.F., C.B.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BBroocks%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Broocks%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AG.%2BBroocks%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-7575-9850" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Broocks</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">T.D. Faizy </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Diagnostic and Interventional Neuroradiology (F.F., H.L., G.B., T.D.F., J.F., C.B.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.D.%2BFaizy%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Faizy%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AT.D.%2BFaizy%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-1631-2020" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T.D. Faizy</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">A. Aigner </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Institute of Medical Biometry and Epidemiology (A.A.)</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Institute of Public Health (A.A.), Charité–Universitätsmedizin Berlin, Berlin, Germany.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BAigner%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Aigner%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.%2BAigner%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4891-8921" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. Aigner</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">M. Deb-Chatterji </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Neurology (M.D.-C., G.T.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BDeb-Chatterji%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Deb-Chatterji%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BDeb-Chatterji%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4282-3518" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Deb-Chatterji</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">G. Thomalla </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Neurology (M.D.-C., G.T.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BThomalla%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Thomalla%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AG.%2BThomalla%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-4785-1449" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Thomalla</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">J. Krauel </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Anaesthesiology (J.K., M.I.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BKrauel%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Krauel%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BKrauel%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4804-5382" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Krauel</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">M. Issleib </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Anaesthesiology (J.K., M.I.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BIssleib%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Issleib%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BIssleib%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-3573-8999" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Issleib</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">J. Fiehler </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Diagnostic and Interventional Neuroradiology (F.F., H.L., G.B., T.D.F., J.F., C.B.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BFiehler%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Fiehler%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BFiehler%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8533-7478" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Fiehler</a></li></ul></div><div class="author-tooltip-10"><div class="author-tooltip-name">C. Brekenfeld </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Diagnostic and Interventional Neuroradiology (F.F., H.L., G.B., T.D.F., J.F., C.B.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BBrekenfeld%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Brekenfeld%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BBrekenfeld%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-6428-2156" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Brekenfeld</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> Mechanical thrombectomy for acute ischemic stroke is performed with the patient under local anesthesia, conscious sedation, or general anesthesia. According to recent trials, up to 16% of patients require emergency conversion to general anesthesia during mechanical thrombectomy. This study investigated the procedural and clinical outcomes after emergency conversion in comparison with local anesthesia, conscious sedation, and general anesthesia.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>MATERIALS AND METHODS:</strong> This retrospective study included 254 patients undergoing mechanical thrombectomy for acute large-vessel occlusion. The procedure was started with the patient either under local anesthesia, conscious sedation, or general anesthesia. Emergency conversion was defined as induction of general anesthesia during mechanical thrombectomy. The primary outcomes were successful reperfusion (TICI 2b/3) and functional independence (mRS at 90 days, ≤2).</p></div><div id="sec-3" class="subsection"><p id="p-3"><strong>RESULTS:</strong> Twenty-five patients (9.8%) required emergency conversion to general anesthesia. The time from admission to flow restoration was increased under general anesthesia (median, 137 minutes) and emergency conversion (median, 138 minutes) compared with local anesthesia (median 110 minutes). After adjustment for confounders, emergency conversion to general anesthesia and primary general anesthesia had comparable chances of successful reperfusion (OR = 1.28; 95% CI, 0.31–5.25). Patients with emergency conversion had a tendency toward higher chances of functional independence (OR = 4.48; 95% CI, 0.49–40.86) compared with primary general anesthesia, but not compared with local anesthesia (OR = 0.86; 95% CI, 0.14–5.11) and conscious sedation (OR = 1.07; 95% CI, 0.17–6.53).</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>CONCLUSIONS:</strong> Patients with emergency conversion did not have lower chances of successful reperfusion or functional independence compared those with primary general anesthesia, and time to flow restoration was also similar. We found no evidence supporting the primary induction of general anesthesia in patients at risk for emergency conversion.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">CS<span class="def-item-dt-sep"></span></dt><dd>conscious sedation<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">GA<span class="def-item-dt-sep"></span></dt><dd>general anesthesia<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">MAP<span class="def-item-dt-sep"></span></dt><dd>mean arterial pressure</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2020 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/41/1/122.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 41</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 1 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jan 2020 </div></div>
      
      
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      <div class="highwire-cite-title">Emergency Conversion to General Anesthesia Is a Tolerable Risk in Patients Undergoing Mechanical Thrombectomy</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Flottmann</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">H.</span> <span class="nlm-surname">Leischner</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Broocks</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">T.D.</span> <span class="nlm-surname">Faizy</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Aigner</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Deb-Chatterji</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Thomalla</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Krauel</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Issleib</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Fiehler</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Brekenfeld</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jan 2020, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">122-127; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6321 </span></div>
  
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Flottmann</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">H.</span> <span class="nlm-surname">Leischner</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Broocks</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">T.D.</span> <span class="nlm-surname">Faizy</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Aigner</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Deb-Chatterji</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Thomalla</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Krauel</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Issleib</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Fiehler</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Brekenfeld</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jan 2020, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">122-127; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6321 </span></div>
  
  
  
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