Stroke center anesthesia practices may shape patient outcomes after mechanical thrombectomy

A hospital’s overall experience with general anesthesia (GA) or conscious sedation (CS) may influence how anesthesia choice affects patient outcomes during mechanical thrombectomy, according to research presented at the Society of NeuroInterventional Surgery (SNIS) 23rd Annual Meeting. The findings suggest that the effectiveness of an anesthesia strategy depends not only on the technique itself, but also on the institutional protocols and experience supporting its use.

Mechanical thrombectomy is a minimally invasive procedure to treat severe strokes, using catheters to quickly reopen blocked arteries in the brain. Patients are usually treated with GA or CS when undergoing thrombectomy.

In the study, “Center-level Utilization of General Anesthesia for Mechanical Thrombectomy is Associated with Mortality, A Neurovascular Quality Initiative Registry Study,” researchers analyzed 9,036 mechanical thrombectomy procedures performed between 2020 and 2025 at 25 stroke centers participating in the Neurovascular Quality Initiative registry. These cases were reported from three CS-dominant centers, 17 GA-dominant centers and five mixed-practice centers.

Analyzing the data, researchers found that CS-dominant centers reported faster door-to-recanalization time, higher First-Pass Effect and lower in-hospital mortality. Compared with CS-dominant centers, GA-dominant centers had nearly quadruple the ICU admission rate and double the median hospital length of stay. However, the benefits of CS were observed only at centers where it was routinely used. At GA-dominant and mixed-practice centers, CS was not associated with lower mortality or faster reperfusion, suggesting that institutional experience may play an important role in patient outcomes.

“As neurointerventional techniques continue to advance, it’s equally important that we evaluate the practices that accompany them,” said Joshua Feler, MD, MS, a Neurosurgical Fellow at Brown University Health’s Neurointerventional Radiology program and the study’s primary author. “Previous studies comparing general anesthesia and conscious sedation have produced mixed results. Our results suggest that differences in institutional experience may help explain those findings and highlight the importance of developing consistent protocols that support high-quality stroke care.”

Future trials should document and account for center-level anesthesia practice patterns when evaluating the effect of anesthetic choice on outcomes.

To receive a copy of this abstract or to speak with the study authors, please contact Camille Jewell at cjewell@vancomm.com or 202-248-5460.