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Pilot RCT assesses feasibility of comparing propofol vs. sevoflurane anesthesia for stroke thrombectomyPilot study tests feasibility of comparing anesthesia types for stroke surgery

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Key Takeaway
Consider pilot RCT findings on anesthetic feasibility for thrombectomy as preliminary; no efficacy conclusions.

This pilot randomized controlled trial assessed the feasibility of conducting a definitive trial comparing anesthetic agents for endovascular thrombectomy. The study enrolled 93 of 201 eligible patients (46.3%) with acute ischemic stroke, with 73 included in the final analysis. Patients were randomized to receive either sevoflurane-based or propofol-based general anesthesia during the procedure. The primary outcomes were feasibility metrics, including recruitment rate, protocol adherence (94.5%), and data completion rate (99%).

Secondary clinical outcomes, including 90-day functional recovery (modified Rankin Scale 0-2) and mortality, showed no statistically significant differences between the two anesthetic groups. The study was not powered to detect clinical differences. An exploratory analysis found that higher admission NIH Stroke Scale scores were associated with mortality, and higher systolic blood pressures both pre-reperfusion (r=0.32, P<0.01) and post-reperfusion (r=0.27, P=0.03) were associated with worse 90-day modified Rankin scores.

Safety and tolerability data for the anesthetic agents were not reported. A key limitation was that the consent and randomization model presented challenges in the acute stroke setting. The authors note that future definitive studies would benefit from a trial design better integrated into clinical workflow. This was a feasibility study; no causal conclusions about the effect of anesthetic choice on clinical outcomes can be drawn from these preliminary data.

Researchers conducted a small pilot study to see if it is possible to run a larger trial comparing two common anesthesia drugs. The study involved 93 patients booked for endovascular thrombectomy, a procedure to clear blocked arteries in the brain. The goal was to test how easy it is to recruit patients and follow the study rules, rather than to prove which drug works best.

The team found that the study process worked well. They successfully enrolled 46% of eligible patients and followed the protocol in over 94% of cases. Data was collected completely in 99% of records. When comparing the two anesthesia groups, there were no differences in functional recovery, death, or early brain improvement. The study also looked at blood pressure control and adverse events, but no specific safety issues were reported.

Because this was a feasibility pilot, no conclusions can be drawn about whether one drug causes better outcomes than the other. The main finding is that future, larger studies could work if they adapt the research model to fit better into clinical workflows. Readers should understand that these preliminary results are not enough to change current medical practice or recommend one drug over another for stroke patients.

What this means for you:
This small pilot study shows the research process is feasible, but results do not prove one anesthesia drug is better.

Study Details

Study typeRct
EvidenceLevel 2
PublishedApr 2026
View Original Abstract ↓
BACKGROUND: Although general anesthesia is commonly utilized for endovascular thrombectomy for acute ischemic stroke, whether anesthetic agents affect clinical outcome is unknown. Retrospective studies comparing propofol and volatile agents have shown mixed results. A randomized controlled trial is needed to determine whether anesthetic agent affects clinical outcomes. This pilot study aimed to evaluate the feasibility of conducting a definitive randomized controlled trial comparing propofol and sevoflurane-based anesthesia in patients undergoing endovascular thrombectomy. METHODS: Patients booked to undergo endovascular thrombectomy were randomized to receive either propofol or sevoflurane-based general anesthesia. Feasibility outcomes assessed were recruitment rate, protocol adherence, and data completeness. Secondary outcomes included functional recovery (90-d modified Rankin Scale 0 to 2), mortality, early neurological improvement, blood pressure control intraoperatively and postoperatively, and adverse events. We also assessed for independent risk factors for functional recovery and death. RESULTS: Of 201 eligible patients, 93 (46.3%) were enrolled and 73 (36.3%) included in the final analysis. The consent and randomization model was challenging. Adherence to drug protocols was 94.5%. Data completion rate was 99%. There were no differences in secondary outcomes between groups. Mortality was associated with higher admission National Institutes of Health Stroke Scale. Higher 90-day modified Rankin scores were associated with higher systolic blood pressures pre-reperfusion ( r =0.32, P <0.01) and post-reperfusion ( r =27, P =0.03). CONCLUSIONS: A definitive randomized controlled trial of propofol and sevoflurane-based anesthesia is feasible. Future studies would benefit from adapting the trial model to better integrate research into the clinical workflow. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12621000074897), January 29, 2021.
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