To explore the effectiveness and safety of local anesthesia as the primary anesthesia mode in mechanical thrombectomy for acute anterior circulation ischemic cerebrovascular disease.

A retrospective analysis was performed on the clinical and surgical data of 124 consecutive enrolled patients with acute anterior circulation ischemic stroke who underwent mechanical thrombectomy from January 2017 to April 2021 at Daxing Teaching Hospital of Capital Medical University. Local anesthesia mode was used as the primary anesthesia method for thrombectomy, and the need to convert to general anesthesia was determined based on the patient's condition during the surgery. Finally, according to the anesthesia method, they were divided into the local anesthesia group (100 cases) and the conversion to general anesthesia group (24 cases). Clinical data of patients were collected. Univariate analysis was used to determine the clinical outcomes and adverse events of cerebral hemorrhage in the two groups, while multivariate logistic regression analysis was used to determine the predictive factors for local anesthesia group patients converting to general anesthesia.

The good prognosis rate of patients in the local anesthesia group at 90 days was higher than that in the conversion to general anesthesia group [61.0% (61/100) vs 12.5% (3/24)], and the mortality rate was lower than that in the conversion to general anesthesia group [9.0% (9/100) vs 37.5% (9/24)], with statistically significant differences（χ²=18.230, 12.669, both P＜0.001). In terms of safety, the proportions of patients with intracranial hemorrhage and symptomatic intracranial hemorrhage between the two groups were 9.0% (9/100), 16.7% (4/24), 3.0% (3/100) and 8.3% (2/24), respectively. There was no significant difference between the two groups (P＞0.05). The results of univariate analysis showed that there was a statistically significant difference in baseline National Institutes of Health Stroke Scale (NIHSS) scores [13(10, 16) vs 16(13, 19)] and thrombectomy frequency [1 (1,2) vs 2(1, 3)] between the local anesthesia group and the conversion to general anesthesia group (Z=2.860, 2.475; P=0.004, 0.013). Multivariate logistic regression analysis showed that preoperative baseline NIHSS score (OR=1.241, 95%CI: 1.020-1.238, P=0.018) and thrombectomy frequency (OR=1.543, 95%CI: 1.028-2.316, P=0.036) were predictive factors for conversion to general anesthesia in patients with acute anterior circulation ischemic stroke undergoing mechanical thrombectomy.

It may be safe and effective to use local anesthesia as the primary anesthesia mode of acute anterior circulation artery occlusion with thrombectomy. The proportion of patients with local anesthesia converted to general anesthesia is relatively low, which is related to the severity of preoperative stroke patients and the thrombectomy frequency.