Evidence map›Paper›PMID 42566703›Full record

Observational studyEuropean stroke journal2026

Effect of anaesthesia modality on outcome in medium or distal vessel occlusion stroke: a post-hoc analysis of the DISTAL trial.

Silja Räty, Daniel Strbian, Laura Mannismäki, Mira Katan, Ronen R Leker, Robin Lemmens, Alejandro Tomasello, Julie Staals, Johannes Kaesmacher, Jan-Hendrik Buhk and 14 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in European stroke journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors.

Silja RätyDepartment of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.ORCID 0000-0002-6921-0597
Daniel StrbianDepartment of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.ORCID 0000-0001-9095-2344
Laura MannismäkiDepartment of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.ORCID 0000-0002-3696-7219
Mira KatanDepartment of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.
Ronen R LekerDepartment of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Robin LemmensDepartment of Neurosciences, Experimental Neurology, KU Leuven, and Department of Neurology, University Hospitals Leuven, Leuven, Belgium.ORCID 0000-0002-4948-5956
Alejandro TomaselloInterventional Neuroradiology Section, Vall d'Hebron University Hospital, Barcelona, Spain.
Julie StaalsDepartment of Neurology, Cardiovascular research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.
Johannes KaesmacherDepartment of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Jan-Hendrik BuhkDepartment of Neuroradiology, Asklepios Hospital St. Georg, Hamburg, Germany.
Marta Olive GadeaStroke Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.ORCID 0000-0003-4637-1598
Juan F ArenillasDepartment of Neurology, Stroke Program and Clinical Neurosciences Research Group, Department of Medicine, University Hospital Valladolid, Valladolid, Spain.
Nicolas Martinez-MajanderDepartment of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.ORCID 0000-0001-8489-7051
Steven D HajduDepartment of Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Patrik MichelDepartment of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.ORCID 0000-0003-4954-7579
Volker PuetzDresden Neurovascular Center, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
Flavio BellanteDepartment of Neurology, Hôpital Civil Marie Curie, Centre Hospitalier Universitaire Charleroi, Charleroi, Belgium.
Sylvie De RaedtDepartment of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), NEUR Research Group, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Daniel BolligerClinic for Anaesthesia, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.ORCID 0000-0003-4094-448X
Vera AebischerDepartment of Diagnostic and Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, University of Basel, Basel, Switzerland.
Nikki RommersDepartment of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland.
Alex BrehmDepartment of Diagnostic and Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, University of Basel, Basel, Switzerland.
Marios PsychogiosDepartment of Diagnostic and Interventional Neuroradiology, Radiology & Nuclear Medicine Clinic, University Hospital Basel, University of Basel, Basel, Switzerland.
Urs FischerDepartment of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.ORCID 0000-0003-0521-4051

Funding

Gottfried und Julia Bangerter-Rhyner-StiftungMedtronicPhenoxRapid Medical and PenumbraStryker NeurovascularSwiss National Science Foundation
6 · The paper itself

Abstract

introductionOf 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

methodsThis 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.

resultsAmong 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

conclusionThe lack of superiority of EVT plus BMT over BMT alone in DISTAL may not have been driven by anaesthesia modality.

Indexed as

Anesthesia, GeneralEndovascular ProceduresProcedural SedationStrokeAgedAnesthesia, LocalFemaleHumansMaleMiddle AgedMulticenter Studies as TopicRandomized Controlled Trials as TopicTreatment Outcomeanaesthesiaendovascular treatmentmedium or distal vessel occlusionstroke

Identifiers

PMID42566703
PMCPMC13450685

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.