When treating acute ischemic stroke with mechanical thrombectomy, clinicians traditionally rely on moderate sedation to keep patients awake yet comfortable. Now, new evidence suggests that placing patients under general anesthesia may lead to better long-term recovery.

This finding comes from a randomized, controlled, multicenter clinical trial led by UTHealth Houston (Houston, TX, USA), marking the first rigorous comparison of anesthesia strategies during the procedure. In the study published in JAMA Neurology, the team studied 260 individuals undergoing thrombectomy, a procedure in which surgeons thread a catheter from the groin to the brain and remove the clot causing the stroke.

Participants were randomly assigned to receive general anesthesia or moderate sedation. After three months, patients in the general anesthesia group showed better neurological outcomes than those sedated moderately. This was notable because prior observational studies had not identified differences in recovery based on anesthesia type. The team’s research is particularly novel because they used a statistical model to focus on a practical sample size.

“About 60 to 70% of the patients who have the thrombectomy return to normal or near normal life. But there’s still about 30 to 40% of patients that might still live with neurological deficits or die. Every step of the thrombectomy can be optimized to improve the outcome of stroke therapy,” said principal investigator Peng Roc Chen, MD. “Hopefully, this will be a wake-up call to change the treatment guidelines.”

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