A recent randomized clinical trial published in JAMA Neurology found that patients with large vessel occlusion acute ischemic stroke who underwent endovascular thrombectomy under general anesthesia experienced better ninety-day functional outcomes and higher rates of successful reperfusion compared with those treated under moderate sedation.

The study enrolled patients with acute ischemic stroke due to large vessel occlusion and randomized them to receive endovascular thrombectomy under either general anesthesia or moderate sedation. The primary endpoint was the proportion of patients achieving a favorable functional outcome, defined as a modified Rankin Scale score of zero to two at ninety days. Secondary endpoints included rates of successful reperfusion and periprocedural complications. Results showed that patients in the general anesthesia group had significantly higher rates of favorable outcomes and successful reperfusion compared with the sedation group. There were no significant differences in the incidence of periprocedural complications between the two groups. These findings suggest that general anesthesia may provide advantages over moderate sedation by optimizing procedural conditions during endovascular thrombectomy for large vessel occlusion stroke, potentially leading to improved clinical outcomes. The authors recommend further studies to confirm these results and investigate the mechanisms contributing to the observed benefits of general anesthesia.

This trial adds to the growing body of evidence guiding anesthetic strategies in acute stroke interventions and may influence clinical practice guidelines regarding the optimal anesthetic approach for endovascular thrombectomy in patients with large vessel occlusion acute ischemic stroke.