distal emboli [78]. One potential drawback of the antegrade approach is the procedural time used for carotid stent placement, as it creates a delay in the time to intracranial reperfusion, possi­bly resulting in an increase of the nal infarct volume [75, 79]. Furthermore, stent retriever-based thrombectomy techniques have the potential of entanglement between the struts of the stent retriever and carotid stent during withdrawal if the guiding cath­eter cannot be advanced through the carotid stent. Moreover, the retrograde approach achieves intracranial recanalization faster, and some purport that this gives better functional outcomes [75]; however, it may be difcult to pass through the proximal occlu­sion, and subsequent emboli from the proximal occlusion can sometimes reocclude the intracranial circulation.

Initial retrospective studies often based their anesthesia choice on patient characteristics and the comfort level of the administra­tor. A retrospective study featuring 1174 patients from 2009 to 2013 concluded that GA was inferior to CS; however, there was limited data on the important factors such as blood pressure and the NIHSS.Furthermore, their outcomes studied were only mor­tality and length of stay [80]. Conversely, another retrospective database study of 2512 patients concluded the opposite: that CS was superior to GA for stroke interventions [81].