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Anesthesia Modality in Intracranial Stenting for Acute Stroke-A Sub-Analysis of the RESISTANT International Registry
Journal article   Open access   Peer reviewed

Anesthesia Modality in Intracranial Stenting for Acute Stroke-A Sub-Analysis of the RESISTANT International Registry

Joao Andre Sousa, Santiago Ortega Gutierrez, Marta Olive-Gadea, Marc Ribo, Francesco Diana, Johannes Kaesmacher, Adnan Mujanovic, Serdar Geyik, Songul Senadim, Amedeo Cervo, …
Clinical neuroradiology (Munich)
02/03/2026
DOI: 10.1007/s00062-026-01619-7
PMID: 41632116
url
https://doi.org/10.1007/s00062-026-01619-7View
Published (Version of record) Open Access

Abstract

PurposeThe optimal anesthetic approach for intracranial stenting in acute stroke remains unclear. We compared outcomes of patients under general anesthesia (GA) versus local anesthesia or conscious sedation.MethodsThe RESISTANT registry is a multicenter observational study on acute intracranial stenting during thrombectomy. Patients treated between January 2016 and June 2023 were included and stratified into GA and local anestesia/conscious sedation groups. The primary outcome was an adjusted shift analysis of the modified Rankin Scale (mRS) at 90 days. Secondary outcomes included mRS 0-2 at 90 days and final modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3 scores. Safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality. Adjusted ordinal and logistic regression with mixed-effects models were performed.ResultsOf 876 patients, 445 (50.8%) received GA. Median age was 67 years [59-77]; 567 (64.8%) were men. No differences were found in 90-day mRS (adjusted common OR = 1.256 [0.887-1.780], p = 0.199). Rates of functional independence (39.0% vs 44.5%; aOR = 0.956 [0.606-1.507], p = 0.846), mTICI 2c/3 (68.9% vs 68.7%; aOR = 0.941 [0.602-1.471], p = 0.790), and sICH (8.0% vs 8.6%; aOR = 0.769 [0.374-1.584], p = 0.477) were comparable. In-hospital (23.0% vs 12.0%; aOR = 2.39 [1.35-4.22], p = 0.003) and 90-day mortality (33.3% vs 21.1%; aOR = 2.017 [1.227-3.315], p = 0.006) were higher in the GA group.ConclusionIn patients undergoing intracranial stenting during thrombectomy, anesthesia modality was not associated with better outcomes. GA was linked to higher mortality, likely due to indication bias.
 Clinical Neurology Life Sciences & Biomedicine Neurosciences & Neurology Radiology, Nuclear Medicine & Medical Imaging Science & Technology

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