Please select the eligibility criteria that correspond to the clinical trial below.
Title: Impact of General vs Local Anesthesia on Neurological Function in Patients With Acute Ischemic Stroke Undergoing Endovascular Treatment
Brief Summary: Recent observational studies have found an association between general anaesthesia and increased post-operative mortality in acute ischemic stroke patients undergoing endovascular treatment. It is unknown whether there is a causal relationship in this observation. The investigators are performing a large randomised trial of general versus local anaesthesia to definitively answer the question of whether anaesthetic type alters perioperative outcome.


Options:
A: Inclusion Criteria:

1. Acute ischemic stroke due to large intracranial vessel occlusion demonstrated on CT-angiography in the following anterior circulation locations that will be treated by endovascular therapy (EVT):

   1. Internal Carotid Artery (terminal "T" or "L-type"- occlusion)
   2. Middle Cerebral Artery (MCA) M1 or proximal M2
   3. Anterior Cerebral Artery (ACA) A1 or proximal A2

      * Patients who receive IV-tPA thrombolysis are eligible provided the drug was delivered within 4.5 hours of stroke onset or last seen normal and in accordance with local hospital standard of care.
2. Ages 18-90.
3. National Institute of Health Stroke Scale (NIHSS) score 6-30
4. Time of from stroke symptom onset of last seen normal to start of EVT (defined as groin puncture) ≤ 16 hours.
5. Limited infarct core, as defined below and adapted from the 2018 American Heart Association guidelines

   1. For patients presenting ≤ 6 hours from time of symptom onset or last seen normal, Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥ 6
   2. For patients presenting \> 6 hours and ≤ 16 hours from time of symptom onset or last seen normal, they must satisfy EITHER ONE of the two following criteria:

   i. Ischemic core by CT Perfusion or MRI/MR Perfusion \< 70 mL, a ratio of volume of penumbral tissue to infarct core of ≥ 1.8, and and absolute volume of penumbral tissue of ≥ 15 mL OR ii. For patients with NIHSS ≥ 10, infarct core of \< 31 mL by CT Perfusion or MRI; For patients with NIHSS ≥ 20, infarct core \< 51 mL.
6. Subject willing/able to return for protocol required follow up visits.
7. No significant pre-stroke disability (modified Rankin Score must be ≤ 2).
8. Females of childbearing potential must have a negative serum or urine pregnancy test.
9. Patient or patient's legally authorized representative has given Informed Consent according to Good Clinical Practices (GCP) and/or local IRB policies.

Exclusion Criteria:

1. Coma on admission (Glasgow Coma Scale \<8), need for intubation upon ED arrival, or transferred patients who present previously intubated.
2. Severe agitation or seizures on admission that preclude safe vascular access.
3. Loss of airway protective reflexes and/or vomiting on admission.
4. Predicted or known difficult airway.
5. Pre-existing neurological or psychiatric disease that would confound the neurological or functional evaluations, e.g. dementia.
6. Presumed septic embolus, or suspicion of bacterial endocarditis
7. Currently participating or has participated in any investigational drug or device study within 30 days.
8. Inability to follow-up for 90-day assessment.
9. Known history of allergy to anesthesia drugs.
10. Known history or family history of malignant hyperthermia
B: Inclusion Criteria:

* Acute anterior circulation ischemic stroke (terminal portion of the internal carotid artery, middle cerebral artery), with indication for radiological mechanical thrombectomy assessed by the neurology / neuroradiology team
* Over 18 years of age
* Benefiting from an affiliation to the French Social Security system
* Patient or familly informed consent. In case of patient incapacity and no family present, and due to the emergency of the procedure, the patient may be included on the sole decision of the investigator (emergency procedure with subsequent differed consent).

Exclusion Criteria:

* Altered vigilance defined by score ≥ 2 at item 1a "level of consciousness" of the NIHSS score
* Altered previous autonomy, defined by a modified Rankin score (mRS)\> 1
* Acute ischemic stroke of posterior circulation or anterior cerebral artery
* Associated brain haemorrhage
* Pregnant or nursing women
* Patient under law protection
* Stroke complicating another acute illness or postoperative stroke.
C: Inclusion Criteria:

* Patients with AIS scheduled to receive emergency endovascular treatment, older than 18; the onset time is within 12 hours.

Exclusion Criteria:

* Radiological ambiguity concerning infarction and vessel occlusion.
* Additional intracerebral hemorrhage.
* Posterior circulation infraction.
* Coma on admission (Glasgow coma score less than 8).
* NIHSS less than 10 or more than 35.
* Severe agitation or seizures on admission.
* Obvious loss of airway protective reflexes and/or vomiting on admission.
* Being intubated before treatment on admission.
* Known allergy to anesthetic or analgesic.
D: Inclusion Criteria:

* age ≥18 years
* acute stroke in anterior circulation
* occlusion of carotid artery and/ or middle cerebral artery
* planned mechanical recanalisation
* informed consent from patient or legal representative

Exclusion Criteria:

* age \< 18 years
* informed consent not obtainable
* coma
* agitation
* vomiting
* difficult airway management
* additional cerebral hemorrhage

Answer: C