Outcomes After Endovascular Therapy With Procedural Sedation vs General Anesthesia in Patients With Acute Ischemic Stroke
Authors: Chabanne Russell , Geeraerts Thomas , Begard Marc , Balança Baptiste , Rapido Francesca , Degos Vincent , Tavernier Benoit , Molliex Serge , Velly Lionel , Verdonk Franck , Lukaszewicz Anne-Claire , Perrigault Pierre-François , Albucher Jean-François , Cognard Christophe , Guyot Adrien , Fernandez Charlotte , Masgrau Aurélie , Moreno Ricardo , Ferrier Anna , Jaber Samir , Bazin Jean-Etienne , Pereira Bruno , Futier Emmanuel ,   ANARLF NetworkAMETIS Study Group, Lagarde Kevin , Cosserant Bernard , Cammas Thibaut , Pascal Julien , Grimaldi Florian , Laroche Erwan , Boissy Camille , Grobost Romain , Pioche Pierre-Antoine , Joffredo Jean-Baptiste , Johanny Audrey , Savranin Denis , Massardier, Julien , Levrier Katia , Brandely Antoine , Langlade Isabelle , Saurel Danielle , Rascol Nicolas , Bailleau Mélanie , Fayon Julie , Vallet Laurent , Caumon Elodie , Rolhion Christine , Morand Dominique , Amat Julien , Jean Betty , Chabert Emmanuel , Zerroug Abderahim , Gabrillargues Jean , Bourgois Nathalie , Moisset Xavier , Clavelou Pierre , Vitello Nicolas , Beilvert Maxime , Aldige Etienne , Mrozek Ségolène , Delort Francois , Naboulsi Edouard , Tardif Elsa , Parry Elodie , Pommier Maxime , Prezman-Pietri Maud , Rousset David , Larcher Claire , Delamarre Louis , Martin Charlotte , Osinski, Diane , Fourcade Olivier , Olivot Jean-Marc , Calviere Lionel , Raposo Nicolas , Viguier Alain , Bonneville Fabrice , Januel Anne-Christine , Tall Philippe , Michelozzi Caterina , Darcourt Jean , Bapteste Lionel , Gemanar Anisoara , Mottolese Catherine , Silve Roxane , Perrigault Pierre-François , Garnier Océane , Ridolfo Jérôme , Bouhaddjar Mokhtar , Fendeleur Julien , Lau Jean Clement , Ratié Mélanie , Costalat Vincent , Cagnazzo Federico , Pasqualotto Romain , Clarencon Frédéric , Torkomian Grégory , Battisti Valentine , Jozefowicz Elsa , Kazemihru Apolline , Henon Hilde , Lafanechere Aurelie , Henry Lois , Bellet Julie , Gaudet Alexandre , Foltzer Fanny , Parmentier Laurie , Magand Clément , Aggour Mohamed , Pregny Anaele , Bonnefoi Marlène , Bruder Nicolas , Vaisse Camille , Bertrandy Michele , Doukhan Laure , Cataldi Sophie , Imane Inal , Verdier Valentine , Sanchez Didier , Dumont Jean-Claude , Fellous Souad , Garnier Marc , Lavabre Olivier , Bernstein David , Baranger Violaine , Thomas Elie , Papagiannaki Chrysanthi , Lenormand Elisabeth , Payen Jean-François , Zuber Mathieu , Molinari Nicolas 
Published: April 2023

Importance

General anesthesia and procedural sedation are common practice for mechanical thrombectomy in acute ischemic stroke. However, risks and benefits of each strategy are unclear.

Objective

To determine whether general anesthesia or procedural sedation for anterior circulation large-vessel occlusion acute ischemic stroke thrombectomy are associated with a difference in periprocedural complications and 3-month functional outcome.

Design, Setting, and Participants

This open-label, blinded end point randomized clinical trial was conducted between August 2017 and February 2020, with final follow-up in May 2020, at 10 centers in France.

Adults with occlusion of the intracranial internal carotid artery and/or the proximal middle cerebral artery treated with thrombectomy were enrolled.

Interventions

Patients were assigned to receive general anesthesia with tracheal intubation (n = 135) or procedural sedation (n = 138).

Main Outcomes and Measures

The prespecified primary composite outcome was functional independence (a score of 0 to 2 on the modified Rankin Scale, which ranges from 0 [no neurologic disability] to 6 [death]) at 90 days and absence of major periprocedural complications (procedure-related serious adverse events, pneumonia, myocardial infarction, cardiogenic acute pulmonary edema, or malignant stroke) at 7 days.

Results

Among 273 patients evaluable for the primary outcome in the modified intention-to-treat population, 142 (52.0%) were women, and the mean (SD) age was 71.6 (13.8) years. The primary outcome occurred in 38 of 135 patients (28.2%) assigned to general anesthesia and in 50 of 138 patients (36.2%) assigned to procedural sedation (absolute difference, 8.1 percentage points; 95% CI, −2.3 to 19.1; P = .15). At 90 days, the rate of patients achieving functional independence was 33.3% (45 of 135) with general anesthesia and 39.1% (54 of 138) with procedural sedation (relative risk, 1.18; 95% CI, 0.86-1.61; P = .32). The rate of patients without major periprocedural complications at 7 days was 65.9% (89 of 135) with general anesthesia and 67.4% (93 of 138) with procedural sedation (relative risk, 1.02; 95% CI, 0.86-1.21; P = .80).

Conclusions and Relevance

In patients treated with mechanical thrombectomy for anterior circulation acute ischemic stroke, general anesthesia and procedural sedation were associated with similar rates of functional independence and major periprocedural complications.

Trial Registration

ClinicalTrials.gov Identifier: NCT03229148