AMETIS
Trial question
Is general anesthesia with tracheal intubation superior to procedural sedation in patients treated with mechanical thrombectomy for anterior circulation AIS?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
52.0% female
48.0% male
N = 273
273 patients (142 female, 131 male)
Inclusion criteria: adult patients treated with mechanical thrombectomy for anterior circulation AIS
Key exclusion criteria: coma or altered vigilance; premorbid disability
Interventions
N=135 general anesthesia (general anesthesia with tracheal intubation)
N=138 procedural sedation (sedation with spontaneous ventilation, targeting minimal to moderate sedation level)
Primary outcome
Functional independence at day 90 and absence of major periprocedural complications at day 7
28.2
36.2
36.2 %
27.2 %
18.1 %
9.1 %
0.0 %
General anesthesia
Procedural sedation
No significant difference ↔
No significant difference in functional independence at day 90 and absence of major periprocedural complications at day 7 (28.2% vs. 36.2%; ARD -8.1, 95% CI -19.1 to 2.3)
Secondary outcomes
No significant difference in procedure-related serious adverse events (6.7% vs. 3.6%; AD 3%, 95% CI -2.1 to 8.2)
No significant difference in excellent recovery at day 90 (14.8% vs. 18.8%; ARD -4, 95% CI -13 to 5)
No significant difference in death at day 90 (18.5% vs. 16.7%; AD 2%, 95% CI -7 to 11)
Conclusion
In adult patients treated with mechanical thrombectomy for anterior circulation AIS, general anesthesia was not superior to procedural sedation with respect to functional independence at day 90 and absence of major periprocedural complications at day 7.
Reference
Russell Chabanne, Thomas Geeraerts, Marc Begard et al. Outcomes After Endovascular Therapy With Procedural Sedation vs General Anesthesia in Patients With Acute Ischemic Stroke: The AMETIS Randomized Clinical Trial. JAMA Neurol. 2023 Apr 3;e230413.
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