***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — Previous work that pre date d the availability of the safer stent-retriever devices has suggested that general anesthesia ( GA ) may have a negative impact on outcomes in patients with acute ischemic stroke undergoing endovascular therapy .  Methods — We review ed demographic , clinical , procedural ( GA versus local anesthesia [ LA ] , etc ) , and site-adjudicated angiographic and clinical outcomes data from consecutive patients treated with the Solitaire FR device in the investigator-initiated North American SOLITAIRE Stent-Retriever Acute Stroke ( NASA ) Registry . The primary outcomes were 90-day modified Rankin Scale , mortality , and symptomatic intracranial hemorrhage . Results — A total of 281 patients from 18 centers were enrolled . GA was used in 69.8 % ( 196/281 ) of patients . Baseline demographic and procedural factors were comparable between the LA and GA groups , except the former demonstrated longer time-to-groin puncture ( 395.4±254 versus 337.4±208 min ; P=0.04 ) , lower National Institutes of Health Stroke Scale ( NIHSS ; 16.2±5.8 versus 18.8±6.9 ; P=0.002 ) , lower balloon-guide catheter usage ( 22.4 % versus 49.2 % ; P=0.0001 ) , and longer fluoroscopy times ( 39.5±33 versus 28±22.8 min ; P=0.008 ) . Recanalization ( thrombolysis in cerebral infa rct ion ≥2b ; 72.94 % versus 73.6 % ; P=0.9 ) and rate of symptomatic intracranial hemorrhage ( 7.1 % versus 11.2 % ; P=0.4 ) were similar but modified Rankin Scale ⩽2 was achieved in more LA patients , 52.6 % versus 35.6 % ( odds ratio , 1.4 [ 1.1–1.8 ] ; P=0.01 ) . In multivariate analysis , hypertension , NIHSS , unsuccessful revascularization , and GA use ( odds ratio , 3.3 [ 1.6–7.1 ] ; P=0.001 ) were associated with death . When only anterior circulation and elective GA patients were included , there was a persistent difference in good outcomes in favor of LA patients ( 50.7 % versus 35.5 % ; odds ratio , 1.3 [ 1.01–1.6 ] ; P=0.04 ) . Conclusions — The NASA Registry has demonstrated that clinical outcomes and survival are significantly better in patients treated with LA , without increased symptomatic intracranial hemorrhage risk . Future trials should prospect ively evaluate the effect of GA on outcomes Background and Purpose — Retrospective studies have found that patients receiving general anesthesia for endovascular treatment in acute ischemic stroke have worse neurological outcome compared with patients receiving conscious sedation . In this prospect i ve r and omized single-center study , we investigated the impact of anesthesia technique on neurological outcome in acute ischemic stroke patients . Methods — Ninety patients receiving endovascular treatment for acute ischemic stroke in 2013 to 2016 were included and r and omized to general anesthesia or conscious sedation .  Difference in neurological outcome at 3 months , measured as modified Rankin Scale score , was analyzed ( primary outcome ) and early neurological improvement of National Institutes of Health Stroke Scale and cerebral infa rct ion volume . Age , sex , comorbidities , admission National Institutes of Health Stroke Scale score , intraprocedural blood pressure , blood glucose , Paco2 and Pco2 modified Thrombolysis in Cerebral Ischemia score , and relevant time intervals were recorded . Results — In the general anesthesia group 19 of 45 patients ( 42.2 % ) and in the conscious sedation group 18 of 45 patients ( 40.0 % ) achieved a modified Rankin Scale score ⩽2 ( P=1.00 ) at 3 months , with no differences in intraoperative blood pressure decline from baseline ( P=0.57 ) ; blood glucose ( P=0.94 ) ; PaCO2 ( P=0.68 ) ; time intervals ( P=0.78 ) ; degree of successful recanalization , 91.1 % versus 88.9 % ( P=1.00 ) ; National Institutes of Health Stroke Scale score at 24 hours 8 ( 3–5 ) versus 9 ( 2–15 ; P=0.60 ) ; infa rct ion volume , 20 ( 10–100 ) versus 20(10–54 ) mL ( P=0.53 ) ; and hospital mortality ( 13.3 % in both groups ; P=1.00 ) . Conclusions — In endovascular treatment for acute ischemic stroke , no difference was found between general anesthesia and conscious sedation in neurological outcome 3 months after stroke . Clinical Trial Registration — URL : https://www . clinical trials.gov . Unique identifier : NCT01872884 BACKGROUND AND PURPOSE : General anesthesia during endovascular treatment of acute ischemic stroke may have an adverse effect on outcome compared with conscious sedation . The aim of this study was to examine the impact of the type of anesthesia on the outcome of patients with acute ischemic stroke treated with the Solitaire stent retriever  , accounting for confounding factors . MATERIAL S AND METHODS : Four-hundred one patients with consecutive acute anterior circulation stroke treated with a Solitaire stent retriever were included in this prospect i ve analysis . Outcome was assessed after 3 months by the modified Rankin Scale . RESULTS : One-hundred thirty-five patients ( 31 % ) underwent endovascular treatment with conscious sedation , and 266 patients ( 69 % ) , with general anesthesia . Patients under general anesthesia had higher NIHSS scores on admission ( 17 versus 13 , P < .001 ) and more internal carotid artery occlusions ( 44.6 % versus 14.8 % , P < .001 ) than patients under conscious sedation . Other baseline characteristics such as time from symptom onset to the start of endovascular treatment did not differ . Favorable outcome ( mRS 0–2 ) was more frequent with conscious sedation ( 47.4 % versus 32 % ; OR , 0.773 ; 95 % CI , 0.646–0.925 ; P = .002 ) in univariable but not multivariable logistic regression analysis ( P = .629 ) . Mortality did not differ ( P = .077 ) . Independent predictors of outcome were age ( OR , 0.95 ; 95 % CI , 0.933–0.969 ; P < .001 ) , NIHSS score ( OR , 0.894 ; 95 % CI , 0.855–0.933 ; P < .001 ) , time from symptom onset to the start of endovascular treatment ( OR , 0.998 ; 95 % CI , 0.996–0.999 ; P = .011 ) , diabetes mellitus ( OR , 0.544 ; 95 % CI , 0.305–0.927 ; P = .04 ) , and symptomatic intracerebral hemorrhage ( OR , 0.109 ; 95 % CI , 0.028–0.428 ; P = .002 ) . CONCLUSIONS : In this single-center study , the anesthetic management during stent retriever thrombectomy with general anesthesia or conscious sedation had no impact on the outcome of patients with large-vessel occlusion in the anterior circulation Purpose To investigate whether the sedation mode ( ie , conscious sedation [ CS ] vs general anesthesia [ GA ] ) affects the angiographic workflow applied for treatment of endovascular stroke in a post hoc analysis of a recent r and omized controlled trial , Sedation versus Intubation for Endovascular Stroke Treatment ( SIESTA ) . Material s and Methods SIESTA was an institutional review board-approved , single-center , prospect i ve , r and omized , parallel-group , open-label treatment trial with a blinded end-point evaluation to compare GA with CS  for treatment of endovascular stroke in 73 and 77 patients , respectively . By using descriptive data from SIESTA , the influence of the mode of sedation on angiographic workflow during treatment for endovascular stroke ( eg , procedure times ) and other radiologic outcome parameters ( eg , radiation exposure ) were analyzed . The time between angiographic key steps for patients who underwent GA and CS was evaluated with t tests . P values were corrected for false discovery rate . Results The median time from groin puncture to first intracranial flow restoration with CS was 47 minutes ( interquartile range [ IQR ] , 29 - 70 minutes ) , and for GA , it was 41 minutes ( IQR , 28 - 60 minutes ) ( P = .546 ) . The median time to the end of angiography with CS was 104 minutes ( IQR , 75 - 150 minutes ) , and with GA , it was 73 minutes ( IQR , 53 - 125 minutes ) ( P = .052 ) . Fluoroscopy time with CS was 49 minutes ( IQR , 25 - 85 minutes ) , and with GA , it was 35 minutes ( IQR , 20 - 74 minutes ) ( P = .098 ) . The times were comparable in both groups for these measures . The time from groin puncture to the final angiographic result with GA , at 72 minutes ( IQR , 45 - 109 minutes ) was shorter than that with CS , at 98 minutes ( IQR , 64 - 135 minutes ) ( P = .048 ) . Conclusion This post hoc analysis of the single-center SIESTA trial revealed that time from groin puncture to final angiographic result was shorter with patients under GA than that with patients under CS . © RSNA , 2017 Online supplemental material is available for this article Importance Optimal management of sedation and airway during thrombectomy for acute ischemic stroke is controversial due to lack of evidence from r and omized trials . Objective To assess whether conscious sedation is superior to general anesthesia for early neurological improvement among patients receiving stroke thrombectomy . Design , Setting , and Participants SIESTA ( Sedation vs Intubation for Endovascular Stroke Treatment ) , a single-center , r and omized , parallel-group , open-label treatment trial with blinded outcome evaluation conducted at Heidelberg University Hospital in Germany ( April 2014-February 2016 ) included 150 patients with acute ischemic stroke in the anterior circulation , higher National Institutes of Health Stroke Scale ( NIHSS ) score ( > 10 ) , and isolated/combined occlusion at any level of the internal carotid or middle cerebral artery . Intervention Patients were r and omly assigned to an intubated general anesthesia group ( n = 73 ) or a nonintubated conscious sedation group ( n = 77 ) during stroke thrombectomy . Main Outcomes and Measures Primary outcome was early neurological improvement on the NIHSS after 24 hours ( 0 - 42 [ none to most severe neurological deficits ; a 4-point difference considered clinical ly relevant ] ) . Secondary outcomes were functional outcome by modified Rankin Scale ( mRS ) after 3 months ( 0 - 6 [ symptom free to dead ] ) , mortality , and peri-interventional parameters of feasibility and safety . Results Among 150 patients ( 60 women [ 40 % ] ; mean age , 71.5 years ; median NIHSS score , 17 ) , primary outcome was not significantly different between the general anesthesia group ( mean NIHSS score , 16.8 at admission vs 13.6 after 24 hours ; difference , -3.2 points [ 95 % CI , -5.6 to -0.8 ] ) vs the conscious sedation group ( mean NIHSS score , 17.2 at admission vs 13.6 after 24 hour ; difference , -3.6 points [ 95 % CI , -5.5 to -1.7 ] ) ; mean difference between groups , -0.4 ( 95 % CI , -3.4 to 2.7 ; P = .82 ) . Of 47 prespecified secondary outcomes analyzed , 41 showed no significant differences . In the general anesthesia vs the conscious sedation group , substantial patient movement was less frequent ( 0 % vs 9.1 % ; difference , 9.1 % ; P = .008 ) , but postinterventional complications were more frequent for hypothermia ( 32.9 % vs 9.1 % ; P < .001 ) , delayed extubation ( 49.3 % vs 6.5 % ; P < .001 ) , and pneumonia ( 13.7 % vs 3.9 % ; P = .03 ) . More patients were functionally independent ( unadjusted mRS score , 0 to 2 after 3 months [ 37.0 % in the general anesthesia group vs 18.2 % in the conscious sedation group P = .01 ] ) . There were no differences in mortality at 3 months ( 24.7 % in both groups ) . Conclusions and Relevance Among patients with acute ischemic 
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The overall analysis including the RCTs and observational studies demonstrated that the functional independence within 90 days occurred more frequently among patients with CS compared with GA ( OR , 1.42 ; 95 % CI , 1.05 - 1.92 , p = 0.02 ) ; and the risk of mortality was higher with GA compared with CS ; furthermore , CS was associated with lower rate of intracranial hemorrhage .
In the overall analysis and observational studies , CS was associated with improved functional outcomes and relatively safe for anterior ischemic stroke compared with GA .
While the pooled data from RCTs suggested that GA was associated with improved outcomes .