The continuous quest for a more tailored approach to anesthetic management of patients undergoing endovascular therapy for acute stroke

To the Editor We read with great interest the article by Pop et al 1 on a propensity score analysis comparing anesthetic management of patients undergoing endovascular therapy for acute stroke. The greatest strength of their article lies in the wise choice of this statistical approach to answer the research question regarding ‘the outcome of stroke mechanical thrombectomy (MT) under local anesthesia (LA)’. Pop et al present a retrospective analysis of prospectively collected endovascular procedure databases of stroke interventions performed in 2018 in two different institutions, Strasbourg and Nancy, adopting two different first-line anesthetic protocols: LA versus general anesthesia (GA) during MT. In doing so, the authors are to be commended for they successfully stayed true to the intention of ‘comparing two anesthetic strategies, and not just different anesthetic methods’ in a real life setting, outside of the strict boundaries of a randomized controlled trial. Pop et al extensively discussed the potential reasons why the use of systematic GA compared with LA was surprisingly associated in their analysis with better 90 day clinical outcome, higher recanalization rates, and fewer procedural complications. However, given …