Multicenter observational study in posterior mechanical thrombectomy: conscious sedation vs general anesthesia. The MORPHEUS stroke registry

Abstract

Background. A number of retrospective studies have suggested that the anesthesia regimen (conscious sedation or general anesthesia) used during endovascular treatment for acute ischemic stroke could have an effect on patient outcomes. Most studies are focused on anterior circulation, so little is known about the real impact of anesthesia on posterior circulation strokes. In this multicentric prospective observatoinal registry, we will investigate the impact of the anesthesia regimen choice on the neurological outcome in acute ischemic posterior circulation stroke patients. Aims. Our primary goal is to evaluate if there is a correlation between general anesthesia and the functional outcome of patients who undergo a mechanical thrombectomy procedure for a posterior circulation stroke. Secondary objectives focus on the role of anesthesia. Study design. Ours is a national, multicentric prospective observational study in which two anesthetic techniques will be compared: conscious sedation (includes local anesthesia alone) versus general anesthesia. Population. Patients diagnosed with an acute posterior circulation ischemic stroke and large vessel arterial occlusion (LVO) whom undergo endovascular treatment will be recruited. After a primary analysis with sample size assessment, a total of 174 patients with a pc-LVO will be necessary to complete the primary objective. 15 hospitals around Spain will participate. The recruitment period is expected to be of 12 months, and the primary analysis will be performed when all patients complete the 3-month follow-up. Methods. The main outcome of this study is the functional independence (modified Rankin Scale from 0 to 2) of patients at 3 months after the stroke. We will compare the functional outcome between the general anesthesia (GA) and the conscious sedation (CS) groups. Relevance. This study will have the ability to offer previously unknown information about the impact of anesthesia on mechanical thrombectomy procedures in patients who have suffered a posterior circulation stroke with LVO. This could potentially start to change the management of these patients in order to improve their functional outcome and to optimize the anesthesia choice during the mechanical thrombectomy procedure