Patients who undergo general anesthesia while receiving a specialized surgery to treat strokes have better outcomes than patients who are moderately sedated, according to new research led by UTHealth Houston.
The findings, published in JAMA Neurology, mark the first time researchers revealed in a randomized, controlled, multicenter trial the differences in anesthesia techniques for patients who undergo endovascular therapy for acute ischemic stroke, said principal investigator Peng Roc Chen, MD. Chen is vice chair of cerebrovascular research, Memorial Hermann Chair, professor, and director of the Cerebrovascular and Endovascular Program and Fellowship in the Vivian L. Smith Department of Neurosurgery at McGovern Medical School at UTHealth Houston.
Acute ischemic strokes occur when a blood clot blocks a vessel in the brain. While clot-busting drugs are often the first course of treatment, many patients are treated through a neuroendovascular procedure known as a mechanical thrombectomy, where surgeons remove the clot by inserting a catheter into the patient’s groin that runs up to the brain. The clot is then removed using another device or suction catheter.
During the procedure, patients can either be moderately sedated, where they’re awake and able to follow some commands, or be placed under general anesthesia. The most common practice is to put patients under moderate sedation, Chen said.
“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,” Chen said. “Every step of the thrombectomy can be optimized to improve the outcome of stroke therapy.”
The multicenter trial enrolled 260 individuals who received a mechanical thrombectomy and were randomly selected to receive either general anesthesia or moderate sedation. According to the research, patients who were placed under general anesthesia had better neurological function after three months compared to patients who were moderately sedated.
“Hopefully this will be a wake-up call to change the treatment guidelines,” Chen said.
Prior studies did not identify any outcome differences between general anesthesia and moderate sedation.
The team’s research is particularly novel because they used a statistical model to focus on a practical sample size, said co-investigator Carlos Artime, MD, executive vice chair for and professor in the Department of Anesthesiology, Critical Care and Pain Medicine at McGovern Medical School.
“This reaffirms that the best thing for patients is to have an anesthesiologist involved, for their comfort and for the proceduralists and surgeons to be able to perform the intervention quickly. It’s a win-win for everyone,” Artime said.
More information:
Peng Roc Chen et al, Sedation vs General Anesthesia for Endovascular Therapy in Acute Ischemic Stroke, JAMA Neurology (2025). DOI: 10.1001/jamaneurol.2025.3775
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