General anesthesia vs. conscious sedation for endovascular treatment of acute basilar artery occlusion: a secondary analysis of the ATTENTION trial

Purpose This study aimed to evaluate the safety and efficacy of endovascular treatment (EVT) performed under general anesthesia (GA) versus conscious sedation (CS) in patients with acute basilar artery occlusion (aBAO). Methods Patients were stratified into GA and CS group. Propensity score matching (1:1) was performed to balanced baseline characteristics. The primary outcome was a favorable functional outcome, defined as a 90-day modified Rankin Scale (mRS) score of 0–2. Secondary outcomes included 90-day mRS 0–1 and 0–3, National Institutes of Health Stroke Scale (NIHSS) scores at 24 and 72 h, successful recanalization, puncture-to-recanalization time, and safety outcomes, including any intracerebral hemorrhage (ICH) and 90-day mortality. Results After propensity score matching, there was no significant between the GA and CS groups (adjusted odds ratio [aOR], 0.97, 95% CI, 0.52–1.84; p = 0.935). Rates of successful recanalization and puncture-to-recanalization time were also comparable between groups. Ninety-day mortality did not differ significantly between CS and GA (adjusted risk ratio: 1.16; 95% CI: 0.70 to 1.91; p = 0.565). Conclusion In patients with aBAO undergoing EVT, CS was associated with clinical and safety outcomes comparable to those observed with GA. However, given the modest sample size and limited statistical power, these findings should be interpreted cautiously.