ADVANCE-STROKE
Anesthetic Strategy During Endovascular Therapy for Acute Ischemic Stroke:
A Nordic Multicenter Randomized Clinical Trial
Project Status:
Planned
Background
Endovascular therapy (EVT) is the standard treatment for acute ischemic stroke caused by large vessel occlusion. However, an important unresolved aspect of EVT care is the choice of anesthetic agent, which may influence patient outcomes.
General anesthesia during EVT is most commonly provided with either propofol or sevoflurane. Previous studies have reported conflicting results, and no adequately powered randomized clinical trial has determined whether one strategy is superior.
The ADVANCE-STROKE trial addresses this knowledge gap by comparing propofol-based and sevoflurane-based anesthesia during EVT. The trial will assess whether anesthetic choice influences functional outcome, with the hypothesis that sevoflurane-based anesthesia improves recovery compared with propofol-based anesthesia.
Intervention
1850 patients undergoing endovascular stroke therapy for acute ischemic stroke will be randomized to:
Sevoflurane-based anesthesia
A
B
Propofol-based anaesthesia
Study design
The ADVANCE-STROKE trial is a Nordic, pragmatic, investigator-initiated, multicenter randomized clinical trial using an adaptive group-sequential design. Patients with acute ischemic stroke undergoing endovascular therapy (EVT) will be randomized to one of two anesthesia strategies, with all patients managed according to a strict physiological protocol.
The primary outcome is functional outcome at 90 days, measured using the Modified Rankin Scale, a widely used measure of disability and independence after stroke. Secondary outcomes include safety outcomes, mechanistic outcomes, a dichotomized functional outcome, and an environmental outcome assessing the carbon footprint associated with the anesthetic strategies.