Evaluation of Moderate Hypercapnia During General Anesthesia for Mechanical Thrombectomy in Acute Ischemic Stroke with Anterior Circulation Large Vessel Occlusion

What this Trial Is About

This research aims to evaluate the effect of moderate hypercapnia on blood flow in the brain's collateral vessels before reperfusion during mechanical thrombectomy for acute ischemic stroke caused by large vessel occlusion in the anterior circulation. The study focuses on improving cerebral blood flow and protecting brain tissue before reopening the blocked vessel under general anesthesia. Mechanical thrombectomy is the current standard treatment for this type of stroke, but ways to enhance blood flow before reperfusion are limited. Patients undergoing thrombectomy under general anesthesia will be randomly assigned to one of two groups. One group will receive moderate hypercapnia targeting an arterial CO2 level (PaCO2) of 50 mmHg, while the other will have normocapnia targeting a PaCO2 of 40 mmHg. The anesthesia protocol includes specific drugs for intubation and maintenance, blood pressure control, and mechanical ventilation settings. Blood gases and cerebral collateral circulation will be monitored before and during the procedure to assess the effect of CO2 modulation. Participants will be closely monitored during the procedure with angiography scans to measure cerebral collateral blood flow scores before reperfusion. Blood gas analyses will be performed at the start and end of the procedure. Researchers will also measure brain infarct volume 24 hours after stroke and neurological outcomes after 3 months. The study involves maintaining specific ventilation targets and blood pressure ranges, with follow-up assessments to evaluate the clinical impact of the treatments over time.

CO2 Modulation in Endovascular Thrombectomy for Acute Ischemic Stroke