General Anesthesia in Stroke Thrombectomy: Enhancing Outcomes

A UTHealth study found that general anesthesia yielded better three-month neurological outcomes than moderate sedation for patients undergoing endovascular thrombectomy. That result has immediate implications for anesthesiology practice, notably periprocedural airway management, hemodynamic strategy, and team workflow.

Earlier evidence left equipoise, with mixed results and clear operational trade-offs among airway control, hemodynamic stability, and procedural throughput. In light of this trial, procedural teams may need to revisit default sedation pathways to balance rapid reperfusion with secure airway and blood‑pressure management and to clarify comparative operational considerations for care teams.

The multicenter randomized trial enrolled 260 patients and randomized them to general anesthesia versus moderate sedation, using three‑month neurological function as the primary endpoint. Patients allocated to general anesthesia demonstrated superior three‑month outcomes. The investigators applied a statistical approach that emphasized practical sample‑size planning and clinically meaningful effect sizes to sharpen inference for real‑world care. Internal validity is supported by randomization and multicenter enrollment; sample size and system‑level generalizability remain limitations.

For anesthesiologists, the findings clarify patient selection priorities, airway and hemodynamic management goals, and coordination with interventional teams. The data support planning for secure airway strategies, tighter blood‑pressure control during reperfusion, and structured communication workflows to reduce delays. When updating thrombectomy pathways, teams can consider protocolized anesthesia pathways that specify candidate selection, airway approach, and blood‑pressure targets.