{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:43:38Z","timestamp":1793105018378,"version":"4.5.0"},"reference-count":26,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"\n Importance<\/jats:title>\n The optimal anesthetic strategy for patients undergoing endovascular therapy (EVT) for acute ischemic stroke (AIS) from large vessel occlusion (LVO) remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine if general anesthesia (GA) or moderate sedation for patients who undergo EVT for AIS with LVO is associated with a different functional outcome in 90 days.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This was a multicenter randomized clinical trial conducted from July 2018 to August 2023 of patients with AIS who were receiving EVT due to LVO. Patients were recruited from 10 comprehensive stroke centers in the US. Adult patients with occlusion of the carotid artery and the proximal middle and anterior cerebral artery who underwent EVT were eligible for enrollment.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Patients were randomized to receive either moderate sedation or GA in 1:1 ratio.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was the ordinal modified Rankin Scale (mRS) score at 90 days.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 1931 patients were screened for eligibility, and 1671 were excluded due to failure meeting the inclusion criteria. Among 260 individuals with a mean (SD) age of 66.8 (13.3) years included in this intention-to-treat study, 133 were male (52%), and 130 (50%) were randomized to GA and sedation each. At 90 days, a shift in the distribution of ordinal mRS was found favoring GA (odds ratio [OR], 1.22; 95% credible interval [CrI], 0.79-1.87) with an 81% posterior probability of GA superiority. The probability that GA was superior to sedation was 89% (relative risk [RR], 1.2; 95% CrI, 0.9-1.66) and 69% (RR, 1.01; 95% CrI, 0.96-1.08) for 90-day mRS 0 to 2 and successful reperfusion, respectively. Other secondary outcomes were similar. Symptomatic intracerebral hemorrhage was 0.8% (1 of 125 patients) in GA vs 2.4% (3 of 125 patients) in sedation with a posterior probability of GA was superior to sedation of 72% (RR, 0.71; 95% CrI, 0.23-2.16).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This randomized clinical trial found that patients with LVO AIS who were treated with EVT using GA had improved rates of 90-day outcomes and higher rates of successful reperfusion compared with those treated using moderate sedation.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03263117<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaneurol.2025.3775","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T15:02:46Z","timestamp":1760367766000},"page":"1265","source":"Crossref","is-referenced-by-count":34,"title":["Sedation vs General Anesthesia for Endovascular Therapy in Acute Ischemic Stroke"],"prefix":"10.1001","volume":"82","author":[{"given":"Peng Roc","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos A.","family":"Artime","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care, and Pain Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil A.","family":"Sheth","sequence":"additional","affiliation":[{"name":"Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Pedroza","sequence":"additional","affiliation":[{"name":"Institute for Clinical Research and Learning Health Care, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Ortega-Gutierrez","sequence":"additional","affiliation":[{"name":"Department of Neurology, Neurosurgery and Radiology, The University of Iowa Carver College of Medicine, University of Iowa Health, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"Wolfe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Health, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clark","family":"Sitton","sequence":"additional","affiliation":[{"name":"Department of Radiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kan","sequence":"additional","affiliation":[{"name":"Robert L. Moody Department of Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Tanweer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Baylor St Luke\u2019s Medical Center, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Chebl","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Medical Center, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens M.","family":"Schirmer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Geisinger and Geisinger College of Health Sciences, Wilkes-Barre, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay T.","family":"Morrow","sequence":"additional","affiliation":[{"name":"Rochester Regional Health Neuroscience Institute, Rochester General Hospital, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yazan J.","family":"Alderazi","sequence":"additional","affiliation":[{"name":"Neuroscience Service Line, Gulf Coast Division, HCA Houston Healthcare, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Bohnstedt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Indiana University School of Medicine, Indiana University Health, Indianapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kadir","family":"Erkmen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar A.","family":"Samaniego","sequence":"additional","affiliation":[{"name":"Department of Neurology, Neurosurgery and Radiology, The University of Iowa Carver 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