General Anesthesia versus Sedation, Both with Hemodynamic Control, during Intraarterial Treatment for Stroke: The...

Area of Science:

• Neurology
• Anesthesiology
• Interventional Radiology

Background:

• Anesthetic approach in endovascular therapy for stroke may influence patient outcomes.
• Conscious sedation was hypothesized to yield better functional outcomes than general anesthesia 3 months post-treatment.

Purpose of the Study:

• To compare the functional outcomes of endovascular therapy for stroke using conscious sedation versus general anesthesia.
• To evaluate secondary outcomes including complications, mortality, and reperfusion rates.

Main Methods:

• A single-blind, randomized trial involving 345 patients undergoing endovascular stroke therapy.
• Patients were assigned to either standardized general anesthesia or conscious sedation with standardized blood pressure control.
• Primary outcome was modified Rankin score ≤2 at 3 months; secondary outcomes included complications, mortality, and reperfusion.

Main Results:

• No significant difference in the primary outcome (modified Rankin score ≤2) between conscious sedation (36%) and general anesthesia (40%) groups (P=0.474).
• General anesthesia group had more intraoperative blood pressure fluctuations but similar cumulative duration.
• Recanalization was more successful in the general anesthesia group (85% vs 75%, P=0.021), while symptomatic intracranial hemorrhage rates were similar.

Conclusions:

• Functional outcomes 3 months after endovascular stroke treatment were comparable between general anesthesia and conscious sedation.
• The study suggests that either anesthetic approach is acceptable for clinicians performing endovascular therapy for stroke.