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Anesthesia Management in Endovascular Therapy for Ischemic Stroke - 2

Sponsor: University Hospital, Clermont-Ferrand • ClinicalTrials.gov ID: NCT07235514

Registry updated: 2026-09-02

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Description

The goal of this clinical trial is to learn what is the best anesthetic management in participants with severe stroke that require a medical intervention called mechanical thrombectomy (MT) done to open the occluded brain vessel. The main question it aims to answer is: • Is general anesthesia (GA) better than procedural sedation (PS) for improving functional performance and decrease dependance in daily life 3 months after stroke? GA (a non-arousable state induced by anesthetic medications that require respiratory assistance) or PS (a state of reduced arousal induced by lesser dose of anesthetic medications that do not require respiratory assistance) are both used for MT. GA enables strict immobility that could facilitate the conduct of MT but lessen blood pressure and blood flow in the brain. PS provides less drop in blood pressure but MT could be more difficult due to possible movement and breathing may be decreased. Researchers will compare GA with PS to see which one is better for MT success and for the functional consequences of stroke. Participants will be treated with GA or PS for the intervention of MT and will be followed by researchers during their hospital stay and asked by a telephone interview how is their functional status 3 months after stroke.

Interventions

General Anesthesia (Procedure)
In the general anesthesia (GA) group with tracheal intubation : Clinical target: unarousable state Standard preoxygenation, • Rapid sequence induction of GA will use intravenous Etomidate (0.2-0.3mg/Kg) or Ketamine (1-2mg/Kg) and Succinylcholine (1mg/Kg) or Rocuronium (1.2 mg/Kg) • Maintenance of GA will use intravenous Propofol (brain tissue target controlled infusion up to 4.0 µg/mL or up to 5.0 mg/kg/hr) or Sevoflurane (end-tidal concentration up to 2% (EtSevo)) and intravenous Remifentanil (brain tissue target controlled infusion up to 4.0 ng/mL) Movement despite unarousable state: NMBA as needed
Procedural sedation (Procedure)
In the procedural sedation group with spontaneous ventilation : Clinical target: alert and "confortable" i.e. minimal to moderate sedation level * Subcutaneous local anesthesia with Lidocaine 10mg/mL (maximum 10mL) * Intravenous Remifentanil as necessary to achieve the sedation clinical target (brain tissue target controlled infusion up to 2.0 ng/mL). Propofol could be added as necessary (brain tissue target controlled infusion up to 3.0 µg/mL or 2.0 mg/kg/hr). The lightest sedation level allowing the intervention has to be sought.

Eligibility criteria

Inclusion Criteria: * Age ≥18 years * Acute ischemic stroke with an occlusion of the intracranial internal carotid artery and/or the proximal middle cerebral artery (M1-M2) with or without association of extracranial occlusion of the cervical internal carotid artery (tandem lesion) * Eligible for mechanical thrombectomy according to international guidelines * Informed and signed consent of patient, or if he is unable to consent the consent of patient's relative or emergency procedure in the absence of relative * National health insurance Exclusion Criteria: * Coma or altered vigilance defined as a score ≥ 2 on the level of consciousness 1A subscale of the NIHSS * Premorbid disability defined as a mRS \> 2 * Posterior circulation stroke * Associated cerebral hemorrhage * Stroke complicating another acute illness or postoperative stroke * Emesis at arrival in angiosuite * Allergy to anesthetic medication * Pregnant or breast-feeding women * Adult under the protection of the law

Conditions

Ischemic Stroke Anterior Cerebral Circulation General Anesthesia Procedural Sedation Thrombectomy

Locations

Le Centre Hospitalier Universitaire d'Angers — Angers, France
Le Centre Hospitalier Universitaire Morvan de Brest de Brest — Brest, France
CHU de Clermont-Ferrand — Clermont-Ferrand, France
Le centre hospitalier universitaire de Lille — Lille, France
Les Hospices Civils de Lyon — Lyon, France
L'Assistance Publique - Hôpitaux de Marseille — Marseille, France
Le centre hospitalier universitaire de Montpellier — Montpellier, France
Le Centre Hospitalier Universitaire de Nantes — Nantes, France
L'Assistance Publique - Hôpitaux de Paris — Paris, France
Le Centre Hospitalier Universitaire de La Réunion — Saint-Denis, France
Le Centre Hospitalier Universitaire de Saint-Etienne — Saint-Etienne, France
Le Centre Hospitalier Universitaire de Strasbourg — Strasbourg, France
L'hôpital Foch — Suresnes, France
Le Centre Hospitalier Universitaire de Bordeaux — Talence, France
Le Centre Hospitalier Universitaire de Toulouse — Toulouse, France
Le Centre Hospitalier Universitaire de Tours — Tours, France

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Official Source

Data sourced from ClinicalTrials.gov, a service of the U.S. National Institutes of Health.

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