The multicentre, randomised SEGA trial has found that acute ischaemic stroke patients who receive endovascular therapy (EVT) under general anaesthesia experience better functional outcomes at 90 days compared to those who receive the procedure under conscious sedation.
These results—presented for the first time at the Society of Vascular and Interventional Neurology (SVIN) annual meeting (16–18 November 2023, Miami, USA) by Peng Roc Chen (University of Texas Health [UTHealth] Houston, USA)—were described by SVIN meeting chair Fawaz Al-Mufti (New York Medical College, New York, USA) as “groundbreaking”.
Across a cohort of 260 patients with acute strokes caused by an anterior-circulation large vessel occlusion, outcomes following EVT under either general anaesthesia or conscious sedation were compared in the trial.
As per SEGA’s primary effectiveness endpoint, general anaesthesia was associated with a higher likelihood of functional independence—measured via modified Rankin scale (mRS) scores—at 90 days. The investigators have reported an odds ratio (OR) of 1.22 favouring general anaesthesia. Overall, a higher percentage of patients experienced mRS scores of 0–1 (30%) and 0–2 (47%) with general anaesthesia as compared to conscious sedation (28% and 39%, respectively) as well.
In addition, one of the trial’s secondary endpoints showed that general anaesthesia led to an increased chance of successful reperfusion (modified thrombolysis in cerebral infarction [mTICI] score ≥2b) versus conscious sedation, with Chen reporting a relative risk (RR) ratio of 1.02 favouring the former.
These data led the SEGA investigators to conclude that patients receiving EVT under general anaesthesia are more likely to achieve a higher grade of angiographic reperfusion, and are also more likely to reach an outcome of functional independence at three months, than those who are treated under conscious sedation.
