General anesthesia leads to better post-surgery outcomes for acute stroke patients compared to moderate sedation, UTHealth Houston researchers discover

General anesthesia leads to better post-surgery outcomes for acute stroke patients compared to moderate sedation, UTHealth Houston researchers discover

Written by: Catherine Marfin | Updated: November 04, 2025

Patients who undergo general anesthesia while receiving a specialized surgery to treat strokes have better outcomes than patients who are moderately sedated, according to new research led by UTHealth Houston.

The findings, published in JAMA Neurology, mark the first time researchers revealed in a randomized, controlled, multicenter trial the differences in anesthesia techniques for patients who undergo endovascular therapy for acute ischemic stroke, said principal investigator Peng Roc Chen, MD. Chen is vice chair of cerebrovascular research, Memorial Hermann Chair, professor, and director of the Cerebrovascular and Endovascular Program and Fellowship in the Vivian L. Smith Department of Neurosurgery at McGovern Medical School at UTHealth Houston.

Acute ischemic strokes occur when a blood clot blocks a vessel in the brain. While clot-busting drugs are often the first course of treatment, many patients are treated through a neuroendovascular procedure known as a mechanical thrombectomy, where surgeons remove the clot by inserting a catheter into the patient's groin that runs up to the brain. The clot is then removed using another device or suction catheter.

During the procedure, patients can either be moderately sedated, where they're awake and able to follow some commands, or be placed under general anesthesia. The most common practice is to put patients under moderate sedation, Chen said.

"About 60 to 70% of the patients who have the thrombectomy return to normal or near normal life. But there's still about 30 to 40% of patients that might still live with neurological deficits or die," Chen said. "Every step of the thrombectomy can be optimized to improve the outcome of stroke therapy."

The multicenter trial enrolled 260 individuals who received a mechanical thrombectomy and were randomly selected to receive either general anesthesia or moderate sedation. According to the research, patients who were placed under general anesthesia had better neurological function after three months compared to patients who were moderately sedated.

"Hopefully this will be a wake-up call to change the treatment guidelines," Chen said.

Prior studies did not identify any outcome differences between general anesthesia and moderate sedation.

The team's research is particularly novel because they used a statistical model to focus on a practical sample size, said co-investigator Carlos Artime, MD, executive vice chair for and professor in the Department of Anesthesiology, Critical Care and Pain Medicine at McGovern Medical School.

"This reaffirms that the best thing for patients is to have an anesthesiologist involved, for their comfort and for the proceduralists and surgeons to be able to perform the intervention quickly. It's a win-win for everyone," Artime said.

Additional researchers from McGovern Medical School include Sunil A. Sheth, MD, associate professor and director of the Vascular Neurology Program; Sean I. Savitz, MD, director of the Institute for Stroke and Cerebrovascular Diseases, professor, and Frank M. Yatsu, MD, Chair in Neurology; Claudia Pedroza, PhD, associate professor of pediatrics; Clark Sitton, MD, professor of diagnostic and interventional imaging; Andrew D. Barreto, MD, professor of neurology; Eddie Aguilar, research coordinator; and Tien Nguyen, research assistant.

Additional authors on the study include: Santiago Ortega-Gutiérrez, MD, MSc; Edgar A. Samaniego, MD; and Elena Garrido, MD, PhD, of the University of Iowa Carver College of Medicine. Stacey Wolfe, MD, of Wake Forest University School of Medicine; Peter Kan, MD, MPH, of The University of Texas Medical Branch at Galveston; Omar Tanweer, MD, of Baylor College of Medicine; Alex Chebl, MD, of the Henry Ford Medical Center; Clemens M. Schirmer, MD, PhD, of the Geisinger College of Health Sciences; Jay T. Morrow, MD, PhD, of the Rochester Regional Health Neuroscience Institute; Yazan J. Alderazi, MD, of HCA Houston Healthcare; Bradley Bohnstedt, MD, of the Indiana University School of Medicine; Kadir Erkmen, MD, of the Lewis Katz School of Medicine; and Allison Engstrom, PhD, of the University of California, Irvine.