Anesthesia Technique and Outcomes in Mechanical Thrombectomy for Acute Ischemic Stroke

Comparison of General Anesthesia and Sedoanalgesia on Mortality and Neurological Outcomes in Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke

This retrospective cohort study examined clinical outcomes in patients who underwent mechanical thrombectomy for acute ischemic stroke under general anesthesia or sedoanalgesia. Patient data from 2014 to 2018 were obtained from hospital medical records. Mortality and neurological outcomes were compared between anesthesia groups.

Study Overview

• Status: Completed
• Conditions: Acute Ischemic Stroke
• Intervention / Treatment: Other: General Anesthesia; Other: Sedoanalgesia

Detailed Description

This retrospective observational cohort study was conducted at the University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital. Medical records of patients who underwent mechanical thrombectomy for acute ischemic stroke between 2014 and 2018 were reviewed. Patients who received mechanical thrombectomy within 6 hours of symptom onset and achieved a Thrombolysis in Cerebral Infarction (TICI) reperfusion grade of 2a, 2b, or 3 were included. Patients with TICI grades of 0 or 1, those younger than 18 years, patients with an APACHE II score ≥25, a Glasgow Coma Scale score <10, those requiring endotracheal intubation before the procedure, or patients discharged from the procedure intubated to the intensive care unit were excluded.

Based on anesthesia records, patients were classified into two cohorts: those who underwent the procedure under general anesthesia and those managed with sedoanalgesia. No assignment to anesthesia technique was performed as part of the study, and anesthesia management was determined according to routine clinical practice. Demographic characteristics, medical history, radiological findings, procedural details, and perioperative variables were extracted from hospital records. Neurological status was assessed using the National Institutes of Health Stroke Scale (NIHSS) at 4 and 24 hours after the procedure, and functional outcome was evaluated using the modified Rankin Scale during hospitalization and at 3 months after thrombectomy. Intraoperative bispectral index (BIS) values and cerebral oxygenation measured by near-infrared spectroscopy (NIRS) were recorded when available. Safety outcomes including peri-procedural hemodynamic instability, vasopressor or antihypertensive use, need for pacing, and intensive care unit (ICU) length of stay will be evaluated.

Neurological outcomes will be assessed longitudinally using NIHSS at baseline, 4 hours, 24 hours, and modified Rankin Scale (mRS/TICI) immediately after the procedure and at 3 months.

The primary outcome of the study was all-cause mortality. Secondary outcomes included neurological and functional outcomes, perioperative variables, intensive care unit length of stay, and procedure-related complications. Comparisons between anesthesia cohorts were performed using routinely collected clinical data. Postoperative delirium occurring during the first 7 days after the procedure was evaluated as a secondary safety outcome when documented in the medical records

• Study Type: Observational
• Enrollment (Actual): 481

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Outside of the US
    • Diyarbakır, Outside of the US, Turkey (Türkiye), 21070
      • Fatma Acil

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consisted of adult patients with acute ischemic stroke who underwent mechanical thrombectomy at the University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital between 2014 and 2018. Patients were treated within 6 hours of symptom onset and achieved successful angiographic reperfusion. Based on anesthesia records, patients were categorized according to anesthesia management as general anesthesia or sedoanalgesia.

Description

Inclusion Criteria:

• Age ≥18 years
• Acute ischemic stroke due to large vessel occlusion (MCA M1)
• Mechanical thrombectomy performed within 6 hours of symptom onset
• Pre-procedural TICI score 0-1

Exclusion Criteria:

• Age ≥100 years
• APACHE II score of 25 or higher
• Glasgow Coma Scale score below 10
• Requirement for endotracheal intubation before the procedure
• Patients discharged from the procedure to the intensive care unit while intubated
• Time from symptom onset to procedure exceeding 6 hours

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
General Anesthesia Group; Patients who underwent mechanical thrombectomy under general anesthesia, based on anesthesia records.	Other: General Anesthesia; Patients who underwent mechanical thrombectomy under general anesthesia, based on anesthesia records.
Sedoanalgesia Group; Patients who underwent mechanical thrombectomy under sedoanalgesia, based on anesthesia records.	Other: Sedoanalgesia; Patients who underwent mechanical thrombectomy under sedoanalgesia, based on anesthesia records.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
All-Cause Mortality	Comparison of all-cause mortality between patients undergoing mechanical thrombectomy under general anesthesia and sedoanalgesia.	During index hospitalization and at 3 months post-procedure

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
NIHSS Score	The National Institutes of Health Stroke Scale (NIHSS) is used to quantify stroke severity (score range 0-42; higher scores indicate more severe stroke)	Baseline, 4 hours, 24 hours post-procedure
Modified Rankin Scale (mRS)	The modified Rankin Scale (mRS) is a global functional outcome measure used after stroke to categorize the level of functional independence.	Immediately after completion of the angiographic procedure and at 3 months after the initial thrombectomy
TICI Reperfusion Grade	The Thrombolysis in Cerebral Infarction (TICI) grading system is used after endovascular revascularization to describe angiographic reperfusion (e.g., 0-3; higher grades indicate better reperfusion)	Immediately after completion of the angiographic procedure and at 3 months after the initial thrombectomy.
Near-Infrared Spectroscopy (NIRS) Values	Regional cerebral oxygen saturation was monitored using near-infrared spectroscopy (NIRS) during the procedure and throughout the early postoperative period.	During index hospitalization and at 3 months post-procedure
Bispectral Index (BIS) Values	Depth of anesthesia was monitored using bispectral index (BIS) values recorded during the procedure.	During the procedure
Procedure Duration	Total duration of the mechanical thrombectomy procedure.	During the procedure
Time From Symptom Onset to Procedure	Elapsed time between symptom onset and initiation of mechanical thrombectomy.	At the time of the procedure
Hemodynamic Parameters	Systolic and diastolic blood pressure values recorded during the perioperative period	From procedure until 3 months post-procedure
Procedure-Related Complications	Occurrence of neurological or procedure-related complications during hospitalization	During hospitalization
Postoperative delirium	Incidence of postoperative delirium during the first 3 postoperative months	Within 30 days after procedure
Postoperative demans	Incidence of postoperative delirium during the first 3 postoperative months	Within 30 days after procedure
ICU Length of Stay	Duration of stay in the intensive care unit following the procedure	Through study completion, an average of 3 months

Collaborators and Investigators

• Sponsor: Saglik Bilimleri Universitesi Gazi Yasargil Training and Research Hospital
• Collaborators: Bakirkoy Dr. Sadi Konuk Research and Training Hospital

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2026
• Primary Completion (Actual): April 4, 2026
• Study Completion (Actual): April 5, 2026

Study Registration Dates

• First Submitted: February 5, 2026
• First Submitted That Met QC Criteria: February 12, 2026
• First Posted (Actual): February 20, 2026

Study Record Updates

• Last Update Posted (Actual): April 8, 2026
• Last Update Submitted That Met QC Criteria: April 7, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: General Anesthesia; Acute Ischemic Stroke; Sedoanalgesia; Mechanical Thrombectomy
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Stroke; Ischemic Stroke; Anesthesia and Analgesia; Anesthesia; Anesthesia, General
• Other Study ID Numbers: 01/20/2026- 13

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No