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More than 20% of patients with a large-vessel ischemic stroke and a large-core infarct at early imaging were functionally independent 90 days after thrombectomy in a large registry study.
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For mechanical thrombectomy stroke patients, consensus guidelines favoring general anesthesia over conscious sedation during the pandemic might need revisiting.
That was the argument presented at the virtual International Stroke Conference (ISC) in a debate over what should be the first-line strategy.
Conscious sedation minimizes delays to treatment, which have been a problem for COVID-19 patients, and provides at least as good outcomes, argued Tudor Jovin, MD, of the Cooper Neurological Institute in Cherry Hill, New Jersey.
He pointed to a prospective study of the Stroke Thrombectomy and Aneurysm Registry (STAR) and Endovascular Neurosurgery Research Group (ENRG) registries showing that 53% of thrombectomy patients who underwent general anesthesia during the pandemic had longer door to reperfusion times (138 vs 100 minutes) and nearly double the mortality risk, as well as lower functional independence scores at discharge.