General anesthesia versus sedation with high-flow nasal cannula for the endovascular treatment of acute ischemic stroke

Prior treatment

• Recent maxillofacial trauma/surgery.

Other illness

• Failure to comply with fasting (6 hours of solids and 2 hours of clear liquids).
• Allergy or intolerance to any of the medications used for sedation or general anesthesia.
• Acute cerebral hemorrhage or clear hemorrhagic transformation in the same vascular territory.

Other

• Coma on admission (Glasgow Coma Scale < 8).
• Baseline severe dependency status (mRS>3).
• Severe/significant agitation on admission.
• Objective loss of airway protection reflexes or vomiting on admission.
• Known or suspected difficult airway on examination.
• Thrombopenia <50,000 or severe coagulation disturbances.

• Age greater than or equal to 18 years.
• NIHSS ≥ 6 and ≤ 25.
• Anterior circulation stroke with isolated or combined occlusion of: - Intracranial Internal Carotid Artery. - Middle Cerebral Artery in its M1 or M2 segments.
• Time of evolution from clinical onset to radiology ward admission < 6 hours, or < 24 hours since last seen asymptomatic if salvageable tissue is demonstrated on neuroimaging tests.
• Informed consent signed by the patient if capable, or by a family member/legal representative if the patient is not capable.