Impact of anesthetic methods on outcomes for patients with large core stroke undergoing endovascular treatment

The optimal anesthetic method for endovascular therapy in acute large core stroke remains unclear. This study aimed to evaluate the impact of anesthetic methods on outcomes in patients with large core stroke.

This study was a subanalysis of a prospective, multicenter registry at 38 stroke centers in China. Patients with large core stroke, defined as an Alberta Stroke Program Early CT Score (ASPECTS) of 0-5 within 24 hours of witnessed symptom onset, were analyzed. The primary outcome was favorable functional outcome (modified Rankin Scale score 0-3) at 90 days.

484 eligible patients were included in this analysis. General anesthesia (GA) was used in 84 patients (17.4%), while non-general anesthesia (non-GA) was used in 400 patients (82.6%). Non-GA was comparable to GA in the primary outcome (37.8% vs 32.1%; adjusted odds ratio (aOR) 1.07, 95% confidence interval (95% CI) 0.60 to 1.91, P=0.83). Mortality at 90 days was 40% in the non-GA and 52.4% in the GA (aOR 0.71, 95% CI 0.41 to 1.22, P=0.21). The proportion of symptomatic intracranial hemorrhage at 48 hours was 13.8% in the non-GA and 11.9% in the GA (aOR 1.25, 95% CI 0.62 to 2.77, P=0.56). The results remained consistent in the propensity score-matched cohort and inverse probability of treatment weighting cohort.

In this cohort study of patients with large core stroke, no significant differences were found in functional and safety outcomes between non-GA and GA.