Choice of Anesthesia for Endovascular Treatment of Acute Ischemic Stroke in Posterior Circulation

Study Overview
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Brief Summary
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There is few randomized controlled clinical to investigated the impact of anesthetic type on outcome in patients with acute ischemic stroke in posterior cerebral circulation. It is unknown whether the choice of anesthesia is impacted on the outcomes for these patients or not. The investigators will perform a randomized controlled pilot clinical trial of general anesthesia versus local anesthesia/conscious sedation to explore and find out a potential fact whether anesthetic type alters perioperative neurological function in patients with acute ischemic stroke in posterior cerebral circulation.

Official Title
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Choice of Anesthesia for Endovascular Treatment of Acute Ischemic Stroke in Posterior Circulation: a Randomized Controlled Exploratory Study (CANVAS-Ⅱ)

Conditions
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Posterior Circulation Brain Infarction

Intervention / Treatment
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* Procedure: General anesthesia
* Procedure: Local anesthesia/concious sedation
* Procedure: Spontaneous breath
* Procedure: Controlled ventilation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with acute ischemic stroke in posterior cerebral circulation scheduled to receive emergency endovascular treatment; Age > 18; The onset time is within 24 hours; Modified rankin score ≤2 before onset. Exclusion Criteria: Radiological ambiguity concerning infarction and vessel occlusion; Additional intracerebral hemorrhage; Anterior circulation infraction; Coma on admission (Glasgow coma score less than 8); NIHSS less than 6 or more than 30; 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;

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Local anesthesia/conscious sedation<br>Patients will be injected by propofol (adjusted by bispectral index scale ≥70 ) and /or remifentanil（0.01-0.06μg/kg/min）. Patients will maintain spontaneous breathing. | Procedure: Local anesthesia/concious sedation<br>* Patients will be injected with propofol and remifentanil.<br>Procedure: Spontaneous breath<br>* Patients will be kept spontaneous breath.<br>|
| Other: General anesthesia<br>Patients will be induced with remifentanil (0.2-0.8 μg/kg), propofol (1-2mg/kg) and rocuronium (0.6 mg/kg). Anesthesia will then be maintained keep the BIS between 40 and 60 with propofol and remifentanil. After tracheal intubation, patients will be kept with controlled ventilation. | Procedure: General anesthesia<br>* Patients will be injected with propofol, remifentanil and muscular relaxant with controlled ventilation.<br>Procedure: Controlled ventilation<br>* Patient will be kept with controlled ventilation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| modified rankin score（mRS） | Modified rankin score（mRS）is used to evaluate the primary outcome. The scale of mRS is 0 to 6. The best neurological outcome is the mRS with 0, indicating no any symptom left, and a good neurological outcome is agreed with a mRS≤2. mRS of 6 is the worst, indicating death. mRS will be evaluated by outcomes assessor who is blinded to the grouping. | post-procedural 90 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Anesthesia Methods, Acute Ischemic Stroke, Endovascular Treatment