SEdation Versus General Anesthesia for Endovascular Therapy in Acute Ischemic Stroke

Inclusion Criteria

• Acute ischemic stroke due to large intracranial vessel occlusion demonstrated on CT-angiography in the following anterior circulation locations that will be treated by endovascular therapy (EVT):
• Internal Carotid Artery (terminal "T" or "L-type"- occlusion)
• Middle Cerebral Artery (MCA) M1 or proximal M2
• Anterior Cerebral Artery (ACA) A1 or proximal A2
• Patients who receive IV-tPA thrombolysis are eligible provided the drug was delivered within 4.5 hours of stroke onset or last seen normal and in accordance with local hospital standard of care.
• Ages 18-90.
• National Institute of Health Stroke Scale (NIHSS) score 6-30
• Time of from stroke symptom onset of last seen normal to start of EVT (defined as groin puncture) ≤ 16 hours.
• Limited infarct core, as defined below and adapted from the 2018 American Heart Association guidelines
• For patients presenting ≤ 6 hours from time of symptom onset or last seen normal, Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥ 6
• For patients presenting > 6 hours and ≤ 16 hours from time of symptom onset or last seen normal, they must satisfy EITHER ONE of the two following criteria:

i. Ischemic core by CT Perfusion or MRI/MR Perfusion < 70 mL, a ratio of volume of penumbral tissue to infarct core of ≥ 1.8, and and absolute volume of penumbral tissue of ≥ 15 mL OR ii. For patients with NIHSS ≥ 10, infarct core of < 31 mL by CT Perfusion or MRI; For patients with NIHSS ≥ 20, infarct core < 51 mL.

• Subject willing/able to return for protocol required follow up visits.
• No significant pre-stroke disability (modified Rankin Score must be ≤ 2).
• Females of childbearing potential must have a negative serum or urine pregnancy test.
• Patient or patient's legally authorized representative has given Informed Consent according to Good Clinical Practices (GCP) and/or local IRB policies.

Exclusion Criteria

• Coma on admission (Glasgow Coma Scale <8), need for intubation upon ED arrival, or transferred patients who present previously intubated.
• Severe agitation or seizures on admission that preclude safe vascular access.
• Loss of airway protective reflexes and/or vomiting on admission.
• Predicted or known difficult airway.
• Pre-existing neurological or psychiatric disease that would confound the neurological or functional evaluations, e.g. dementia.
• Presumed septic embolus, or suspicion of bacterial endocarditis
• Currently participating or has participated in any investigational drug or device study within 30 days.
• Inability to follow-up for 90-day assessment.
• Known history of allergy to anesthesia drugs.
• Known history or family history of malignant hyperthermia