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Aniello Iovino 1 Article
Basic science and research
Anesthesiological management in endovascular mechanical thrombectomy: a propensity score-matched retrospective analysis in Italy
Antonio Romanelli, Aniello Iovino, Daniele Giuseppe Romano, Antonella Langone, Rosa Napoletano, Giulia Frauenfelder, Flora Minichino, Liliana D’Ambrosio, Miriam Caterino, Raffaele Tortora, Renato Gammaldi, Paolo Barone, Renato Saponiero
Received July 23, 2024  Accepted November 19, 2024  Published online January 3, 2025  
DOI: https://doi.org/10.4266/acc.003000
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AbstractAbstract
Background
Endovascular mechanical thrombectomy (EMT) can be performed with general anesthesia (GA) or using non-GA techniques. Several meta-analyses on the topic have reported discordant main outcomes. The aim of this retrospective single-center study was to analyze the relationship between clinical outcomes and anesthesiological management (GA vs. non-GA) in patients who underwent EMT for acute anterior ischemic stroke (AIS).
Methods
We performed a propensity score-matched (PSM) analysis of patients who underwent EMT for acute AIS from January 2018 to December 2021. For PSM, we chose covariates influencing clinical decisions about anesthesiological management. Comparisons between groups were performed with the chi-square test for categorical variables and Student t-test or the Mann-Whitney U-test for continuous variables as appropriate. The relationships between anesthesiological management and clinical outcomes were analyzed using logistic regression, and results are reported as odds ratios with 95% confidence intervals. A two-sided P-value <0.05 was considered statistically significant.
Results
From 194 observations (78 in the GA group, 116 in the non-GA group), after PSM, we obtained 70 data pairs. Both anesthesiological approaches resulted in similar rates of in-hospital mortality, 90-day functional independence, full recanalization, procedural complications, and intracerebral hemorrhage (ICH). Performing EMT with GA was unrelated to the in-hospital and 90-day death rates, 90-day functional independence, full recanalization rate, procedural complications, and ICH (P>0.05).
Conclusions
Anesthesiological management did not influence clinical outcomes of EMT for acute AIS. Physiological stability during EMT may impact outcomes more significantly than anesthesiological management. Further studies on this topic are needed.

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