Effect of anaesthesia modality on outcome in medium or distal vessel occlusion stroke: a post-hoc analysis of the DISTAL trial
In brief
Local anesthesia improves outcome and halves death risk in distal stroke EVT
In a post-hoc analysis of 491 patients with medium or distal vessel occlusion, endovascular treatment under local anesthesia was linked to twice the odds of a better 90-day functional score and a 72% lower mortality compared with conscious sedation, while general anesthesia raised symptomatic bleed risk. These findings suggest anaesthesia choice may influence EVT benefits, but overall EVT did not outperform medical therapy.
- Journal
- European stroke journal (Q1)
- Published
- 5 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Silja Räty, Daniel Strbian, Laura Mannismäki, Mira Katan, Ronen R Leker, Robin Lemmens, et al.
- PMID
- 42566703
- DOI
- 10.1093/esj/aakag088
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (top studies of the week, 9 August 2026).
Abstract
INTRODUCTION: Of the 3 published trials, only 1 showed possible efficacy of endovascular treatment (EVT) compared to best medical treatment (BMT) alone for medium or distal vessel occlusions (MDVO), whereas the others were neutral. Procedural conditions may affect the outcome. PATIENTS AND METHODS: This is a post-hoc analysis of the randomised, controlled DISTAL trial, conducted in 55 centers between 12/2021 and 7/2024. Patients with isolated MDVO within 24 hours of last seen well randomised to EVT plus BMT were treated under general anaesthesia (GA), conscious sedation (CS) or local anaesthesia (LA) at investigators' discretion. Endovascular treatment under different anaesthesia modalities was compared head-to-head, and to BMT alone. RESULTS: Among 491 patients included in the analysis, 224 received EVT plus BMT (108 GA, 64 LA, 52 CS) and 267 received BMT alone. Compared to BMT alone, EVT under CS was associated with worse 90-day modified Rankin Scale (median 2.5 vs 2.0; adjusted odds ratio [aOR] 0.51 [95% CI 0.29-0.90]), whereas no difference was observed between EVT under other anaesthesia modalities and BMT alone. Symptomatic intracranial haemorrhage occurred more frequently after EVT under GA compared to BMT alone (8.3% vs 2.6%; aOR 3.37 [95% CI, 1.22-9.66]). LA was associated with higher odds of better functional outcome (aOR 2.11 [95% CI, 1.09-4.12]) and lower mortality (aOR 0.28 [95% CI, 0.08-0.95]) compared to CS, whereas there was no difference to GA. DISCUSSION AND CONCLUSION: The lack of superiority of EVT plus BMT over BMT alone in DISTAL may not have been driven by anaesthesia modality.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.