This study investigates the impact of general anesthesia (GA) versus conscious sedation/local anesthesia (CS/LA) on the outcome of patients with minor stroke and isolated M2 occlusion undergoing immediate mechanical thrombectomy (iMT). The databases of 16 comprehensive stroke centers were retrospectively screened for consecutive patients with isolated M2 occlusion and a baseline National Institute of Health Stroke Scale score ≤ 5 who received iMT. Propensity score matching (PSM) was used to estimate the effect of GA versus CS/LA on clinical outcome and procedure-related adverse events. Primary outcome measure was a 90-day modified Rankin Scale (mRS) score 0-1. Secondary outcome measures were 90-day mRS score 0-2 and all-cause mortality, successful reperfusion, procedural-related symptomatic subarachnoid hemorrhage (sSAH), intraprocedural dissections and new territory embolism. Of the 172 patients that were selected, 55 received GA and 117 CS/LA. After PSM, 47 pairs of patients were available for analysis. We found no significant differences in clinical outcome, rates of efficient reperfusion and procedural-related complications between patients receiving GA or LA/CS. (mRS 0-1: p=0.815; mRS 0-2: p=0.401; all-cause mortality: p=0.408; modified Treatment In Cerebral Infarction score 2b-3: p=0.374; sSAH: p=0.082; intraprocedural dissection: p=0.408; new territory embolism: p=0.462) CONCLUSIONS: In patients with minor stroke and isolated M2 occlusion undergoing iMT, the type of anesthesia does not affect clinical outcome or the rate of procedural-related complications. Our results agree with recent data showing no benefit of one specific anesthesiologic procedure over the other and confirm their generalizability also to patients with minor baseline symptoms.

Current non-invasive diagnostic modalities of iatrogenic bile leak (BL) are not particularly sensitive and often fail to localise the BL origin. Percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) are considered the gold standard, yet are invasive studies with potential complications. Ce-MRCP has been not comprehensively studied in this setting but may prove particularly helpful given its non-invasive nature and the anatomical dynamic detail. This paper reports a monocentric retrospective study of BL patients referred between January 2018 and November 2022 submitted to Ce-MRCP followed by PTC. The primary outcome was the accuracy of Ce-MRCP in detecting and localising BL compared to PTC and ERCP. Blood tests, coexisting cholangitis features and time for leak resolution were also investigated. Thirty-nine patients were included. Liver-specific contrast-enhanced MRCP detected BL in 69% of cases. The BL localisation was 100% accurate. Total bilirubin above 4 mg/dL was significantly associated with false negative results of Ce-MRCP. Ce-MRCP is highly accurate in detecting and localising BL, but sensitivity is significantly reduced by a high bilirubin level. Ce-MRCP may be very useful in early BL diagnosis and in accurate pre-treatment planning, but can only be reliably used in selected patients with TB < 4 mg/dL. Non-surgical techniques, both radiological and endoscopic, are proven to be effective in terms of leak resolution.

Article: Dual-layered micromesh stent technology for embolic prevention in carotid revascularization: technical experience and clinical outcomes from a high-volume interventional radiology center - The Journal of Cardiovascular Surgery 2024 May 10 - Minerva Medica - Journals