When do you consider using general anesthesia for endovascular thrombectomy?

I perform all of my thrombectomy cases under general anesthesia. There is better hemodynamic control, no patient movement to manage, which increases procedural efficiency as a result. In moderate sedation cases, patients can feel aspiration and stent retriever passes through the vessel, which causes or worsens agitation mid-procedure and can lead to technical difficulties that directly affect reperfusion quality. Managing an agitated or moving patient also adds an element of operator fatigue and may lower the threshold to conclude a case, based on my personal experience with both approaches.

The data support these aspects of GA in the setting of thrombectomy. SEGA, a recent multicenter RCT, showed a 90-day functional outcome shift favoring ...