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Purpose <p>The 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.</p> Methods <p>The RESISTANT registry is a&#xa0;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&#xa0;days. Secondary outcomes included mRS 0–2 at 90&#xa0;days and final modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3&#xa0;scores. Safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality. Adjusted ordinal and logistic regression with mixed-effects models were performed.</p> Results <p>Of 876 patients, 445 (50.8%) received GA. Median age was 67&#xa0;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], <i>p</i> = 0.199). Rates of functional independence (39.0% vs 44.5%; aOR = 0.956 [0.606–1.507], <i>p</i> = 0.846), mTICI&#xa0;2c/3 (68.9% vs 68.7%; aOR = 0.941 [0.602–1.471], <i>p</i> = 0.790), and sICH (8.0% vs 8.6%; aOR = 0.769 [0.374–1.584], <i>p</i> = 0.477) were comparable. In-hospital (23.0% vs 12.0%; aOR = 2.39 [1.35–4.22], <i>p</i> = 0.003) and 90-day mortality (33.3% vs 21.1%; aOR = 2.017 [1.227–3.315], <i>p</i> = 0.006) were higher in the GA group.</p> Conclusion <p>In 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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月3日

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  • João André Sousa,
  • Marta Olivé-Gadea,
  • Francesco Diana,
  • Johannes Kaesmacher,
  • Adnan Mujanovic,
  • Serdar Geyik,
  • Songul Senadim,
  • Amedeo Cervo,
  • Andrea Salcuni,
  • Mariangela Piano,
  • Manuel Moreu,
  • Alfonso López-Frías,
  • Ameer Hassan,
  • Samantha Miller,
  • Elena Zapata-Arriaza,
  • Asier de Albóniga-Chindurza,
  • Mauro Bergui,
  • Stefano Molinaro,
  • Fabio Gomes,
  • Joao Sargento-Freitas,
  • Andrea Alexandre,
  • Alessandro Pedicelli,
  • Jeremy Hofmeister,
  • Paolo Machi,
  • Luca Scarcia,
  • Erwah Kalsoum,
  • Jose Amorim,
  • Torcato Meira,
  • Santiago Ortega Gutierrez,
  • Aaron Rodriguez-Calienes,
  • Leonardo Renieri,
  • Francesco Capasso,
  • Daniele Romano,
  • Eduardo Bárcena-Ruiz,
  • David Seoane,
  • Mohamad Abdalkader,
  • Piers Klein,
  • Thanh N. Nguyen,
  • Catarina Perry,
  • Isabel Fragata,
  • Dileep Yavagal,
  • Jude Charles,
  • Jose Rodriguez Castro,
  • Pedro Vega,
  • Atilla Özcan Özdemir,
  • Zehra Uysal Kocabaş,
  • Stanislas Smajda,
  • Sadiq Al Salman,
  • Jane Khalife,
  • Tudor Jovin,
  • Francesco Biraschi,
  • Francesca Ricchetti,
  • Pedro Castro,
  • Luis Albuquerque,
  • Adnan Siddiqui,
  • Vinay Jaikumar,
  • Pedro Navia,
  • Nikos Ntoulias,
  • Marios Psychogios,
  • Mariano Velo,
  • Joaquin Zamarro,
  • Gonzalo De Paco,
  • Yazan Ashouri,
  • Mohammad AlMajali,
  • Juan F. Arenillas,
  • Alicia Sierra,
  • Michele Romoli,
  • João Pedro Marto,
  • Shadi Yaghi,
  • Marc Ribo,
  • Alejandro Tomasello,
  • Manuel Requena

摘要

Purpose

The 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.

Methods

The 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.

Results

Of 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.

Conclusion

In 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.