Journal article
General vs Nongeneral Anesthesia for Endovascular Thrombectomy in Patients With Large Core Strokes: A Prespecified Secondary Analysis of SELECT2 Trial
Neurology, Vol.105(2), e213819
07/22/2025
DOI: 10.1212/WNL.0000000000213819
PMID: 40570276
Abstract
The association of anesthesia approach during endovascular thrombectomy (EVT) with clinical outcomes in large strokes is unexplored. We aimed to evaluate whether general anesthesia (GA), compared with non-GA, was associated with better functional outcomes in the SELECT2 trial.
In a prespecified secondary analysis of the SELECT2 trial that enrolled patients with large strokes on noncontrast CT (Alberta Stroke Program Early CT Score [ASPECTS] 3-5), CT perfusion/MRI (core volume ≥50 mL), or both, functional outcomes were compared in EVT-treated patients who received GA or non-GA and whether this association was modified by stroke severity (NIH Stroke Scale score), ischemic injury estimates, and collateral status was evaluated. The primary outcome was 90-day functional status (ordinal modified Rankin Scale [mRS]). Secondary outcomes were functional independence (mRS scores 0-2), independent ambulation (mRS scores 0-3), complete dependence or death (mRS scores 5-6), and mortality.
Of 178 EVT patients (median [interquartile range] age 66 [58-75] years, stroke severity 19 [15-23], CT-ASPECTS 4 [3-5], and core volume 101.5 [70-138] mL, 71 women [39.9%]), 104 (58%) received GA. Time from randomization to arterial puncture was longer with GA (40 [23-59] minutes) vs non-GA (27 [18-47] minutes), but procedural duration (GA: 57 [31.5-77] minutes vs non-GA: 49.5 [30-71] minutes) was similar. Successful reperfusion (modified treatment in cerebral infarction [mTICI] score 2b-3) rates were similar (GA 81 (78%) vs non-GA 62 (84%), adjusted relative risk [aRR] 0.91, 95% CI 0.79-1.06). In addition, mRS distribution did not differ between GA and non-GA groups (adjusted generalized odds ratio 1.21, 95% CI 0.86-1.70), as well as independent ambulation (GA: 41% vs non-GA: 34%, aRR 1.22, 95% CI 0.86-1.74) and functional independence (GA: 22% vs non-GA: 18%, aRR 1.32, 95% CI 0.75-2.35). Stroke severity, ASPECTS, ischemic core volume, or collaterals did not modify the association between anesthesia and functional outcome (all
-interaction >0.05). Patients experienced systolic blood pressure (SBP) variability ≥40 mm Hg and minimum intraprocedural SBP (<100 mm Hg) more frequently with GA, but this did not modify GA association with functional outcomes (
-interaction = 0.77 and 0.89, respectively).
In patients with large core strokes randomized in SELECT2, EVT outcomes did not differ significantly based on anesthesia approach (GA or non-GA) without heterogeneity across stroke severity and size. While GA was associated with higher SBP variability and lower minimum SBP, this did not modify GA association with functional outcomes. While allocation to anesthesia approach was nonrandomized, our findings suggest that optimizing institutional protocols for preferred anesthesia technique, whether GA or non-GA, may enhance EVT procedural outcomes.
ClinicalTrials.gov ID: NCT03876457.
This study provides Class II evidence that in patients presenting within 24 hours with large vessel occlusion strokes undergoing EVT, the 90-day mRS score is comparable in those with or without GA.
Details
- Title: Subtitle
- General vs Nongeneral Anesthesia for Endovascular Thrombectomy in Patients With Large Core Strokes: A Prespecified Secondary Analysis of SELECT2 Trial
- Creators
- Amrou Sarraj - Case Western Reserve UniversitySpiros Blackburn - The University of Texas Health Science Center at HoustonMichael G Abraham - University of Kansas Medical CenterMuhammad S Hussain - Cleveland ClinicSantiago Ortega-Gutierrez - University of Iowa Hospitals and Clinics, Iowa CityMichael Chen - Rush University Medical CenterScott E Kasner - University of PennsylvaniaLeonid Churilov - The Royal Melbourne HospitalClark W Sitton - The University of Texas Health Science Center at HoustonDeep K Pujara - Case Western Reserve UniversitySophia Sundararajan - Case Western Reserve UniversityYin C Hu - Case Western Reserve UniversityNabeel A Herial - Thomas Jefferson University HospitalRonald F Budzik - Riverside Methodist HospitalWilliam J Hicks - Riverside Methodist HospitalNirav Vora - Riverside Methodist HospitalJuan F Arenillas - Hospital Clínico Universitario Valladolid, University of Valladolid, SpainMercedes De Lara Alfonso - Hospital Clínico Universitario Valladolid, University of Valladolid, SpainMaria E Ramos Araque - Hospital Clínico Universitario Valladolid, University of Valladolid, SpainJenny P Tsai - Cleveland ClinicMohammed A Abdulrazzak - Cleveland ClinicOsman Kozak - Thomas Jefferson University HospitalBernard Yan - The Royal Melbourne HospitalPeter J Mitchell - The Royal Melbourne HospitalDennis J Cordato - Liverpool HospitalNathan W Manning - Liverpool HospitalAndrew Cheung - Liverpool HospitalRicardo A Hanel - Baptist Medical Center JacksonvilleAmin N Aghaebrahim - Baptist Medical Center JacksonvilleTeddy Y Wu - Christchurch HospitalPere Cardona Portela - Hospital Universitari de Bellvitge, Barcelona, Catalonia, SpainAndres J Paipa Merchán - Hospital Universitari de Bellvitge, Barcelona, Catalonia, SpainChirag D Gandhi - Westchester Medical CenterFawaz Al-Mufti - Westchester Medical CenterEdgar A Samaniego - University of Iowa Hospitals and Clinics, Iowa CityLaith Maali - University of Kansas Medical CenterAbed Qureshi - University of Kansas Medical CenterColleen G Lechtenberg - University of Kansas Medical CenterSabreena Slavin - University of Kansas Medical CenterLee Rosterman - University of Kansas Medical CenterDaniel Gibson - Columbia St. Mary's HospitalAdam N Wallace - Aurora Health CareDaniel SahleinNatalia Pérez de la Ossa - Hospital Universitari Germans Trias i PujolMaria Hernández Pérez - Hospital Universitari Germans Trias i PujolJoanna D Schaafsma - Toronto Western HospitalJordi Blasco - Hospital Clínic de BarcelonaArturo Renú - Hospital Clínic de BarcelonaNavdeep Sangha - Kaiser PermanenteSteven Warach - The University of Texas at AustinTimothy J Kleinig - Royal Adelaide HospitalMichael Mullen - Temple University HospitalLucas Elijovich - Semmes Murphey Clinic, Memphis, TNFaris Shaker - McGovern Medical School at UTHealth, Houston, TXFaisal K Al-Shaibi - Case Western Reserve UniversityHannah Johns - The Royal Melbourne HospitalKelsey R Duncan - Case Western Reserve UniversityAmanda Opaskar - Case Western Reserve UniversityMarc J Popovic - Case Western Reserve UniversityMichael Altose - Case Western Reserve UniversityAbhishek Ray - Case Western Reserve UniversityWei Xiong - Case Western Reserve UniversityJeffrey Sunshine - Case Western Reserve UniversityMichael DeGeorgia - Case Western Reserve UniversityThanh N Nguyen - Boston Medical CenterJohanna T Fifi - Icahn School of Medicine at Mount SinaiStavropoula Tjoumakaris - Thomas Jefferson University HospitalPascal Jabbour - Thomas Jefferson University HospitalVitor Mendes Pereira - St. Michael's HospitalMaarten G Lansberg - Stanford UniversityGreg W Albers - Stanford UniversityCathy Sila - Case Western Reserve UniversityNicholas Bambakidis - University Hospitals of ClevelandStephen Davis - The Royal Melbourne HospitalLawrence Wechsler - University of PennsylvaniaMichael D Hill - University of CalgaryJames C Grotta - Memorial HermannMarc Ribo - Hospital Vall d'Hebrón, Barcelona, Catalonia, SpainAmeer E HassanBruce C Campbell - The Royal Melbourne HospitalSELECT2 Investigators
- Resource Type
- Journal article
- Publication Details
- Neurology, Vol.105(2), e213819
- DOI
- 10.1212/WNL.0000000000213819
- PMID
- 40570276
- NLM abbreviation
- Neurology
- ISSN
- 0028-3878
- eISSN
- 1526-632X
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS; PHILADELPHIA
- Grant note
- Stryker Neurovascular
SELECT2 was funded by Stryker Neurovascular through institutional grant to UT McGovern Medical School and UH Cleveland Medical Center. This secondary analysis from SELECT2 trial received no funding.
- Language
- English
- Date published
- 07/22/2025
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984833484702771
Metrics
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