Anaesthesiological Care for Endovascular Thrombectomy in Acute Ischaemic Stroke (ACT in Stroke)

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About one third of strokes is caused by occlusion of a large artery supplying the brain. In those cases, swift removal of the blood clot from the vessel can reverse the patient’s symptoms. For this procedure called endovascular thrombectomy, a neuroradiologist punctures the femoral artery, threads a catheter up the aorta to the obstruction in the cerebral artery, and tries to re-establish blood flow to the brain tissue downstream. In order to safely and effectively manipulate the catheter in the vasculature, the patient’s immobility is crucial. Unfortunately, many patients acutely afflicted by stroke are scared and restless, and when their speech comprehension is impaired, they will be entirely inaccessible to verbal reassurance. At this point, anaesthesiologists are required to establish adequate conditions for the intervention. However, it is yet unclear whether sedation with preserved spontaneous ventilation or general anaesthesia with controlled mechanical ventilation is better with regard to the patient’s functional outcome three months later. We have planned a national multicentre, prospective, randomized, controlled trial with blinded outcome assessment to answer this question. Patients with an acute occlusion in the anterior cerebral circulation that have been selected by a neurologist and/or neuroradiologist to undergo endovascular thrombectomy shall be randomized to receive general anaesthesia or conscious sedation according to standard clinical practice of the respective centre. We hypothesize that general anaesthesia during endovascular thrombectomy enhances stroke patients’ functional outcome measured three months after the insult.