Neurology最新文献

{"title":"Intra-Arterial Thrombolysis Following Endovascular Recanalization for Large Vessel Occlusion Stroke: A Systematic Review and Meta-Analysis.","authors":"Xin Jiang, Zixu Zhao, Ying Zhang, Wei Luo, Keyang Zheng, Minghui Zhang, Enze Li, Hui Lang, Jian Wang, Can Zhou, Li He","doi":"10.1212/WNL.0000000000213842","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213842","url":null,"abstract":"<p><strong>Background and objectives: </strong>This systematic review and meta-analysis aims to evaluate the treatment effects of intra-arterial thrombolysis (IAT) after endovascular recanalization in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Endovascular recanalization is the standard treatment for large vessel occlusion (LVO) stroke. Despite successful reperfusion after thrombectomy, fewer than half of the patients regain functional independence at 90 days, highlighting the potential role of impaired microcirculation in poor neurologic outcomes. The efficacy and safety of intra-arterial thrombolysis (IAT) after endovascular recanalization remains controversial. This systematic review and meta-analysis aims to evaluate the treatment effects of IAT after endovascular recanalization in patients with acute ischemic stroke (AIS) due to LVO.</p><p><strong>Methods: </strong>We conducted a study-level systematic review and meta-analysis based on PubMed, Embase, CENTRAL, and ClinicalTrials.gov from database inception to February 8, 2025. Only randomized controlled trials (RCTs) reporting the efficacy and safety of IAT after endovascular recanalization in large vessel occlusion stroke were included. The risk of bias of the included studies was assessed using the Risk of Bias 2 tool. The pooled data were analyzed using a random-effects meta-analysis. Our primary outcome was the proportion of patients with modified Rankin Scale (mRS) scores 0-1 at 90 days. Other outcomes included the proportion of patients with mRS scores 0-2 at 90 days, all-cause mortality at 90 days, and symptomatic intracranial hemorrhage and any intracranial hemorrhage within 48 hours. The study protocol was registered on PROSPERO (CRD42025639519).</p><p><strong>Results: </strong>A total of 6 RCTs with 1,985 initially enrolled patients were included in the analysis. A higher proportion of mRS scores 0-1 at 90 days was observed in the IAT group (risk ratio [RR] 1.25, 95% CI 1.11-1.41). No significant differences were found in the proportion of mRS scores 0-2 at 90 days (RR 1.04, 95% CI 0.96-1.13) between the groups. Regarding safety outcomes, 90-day all-cause mortality (RR 1.00, 95% CI 0.83-1.21), symptomatic intracranial hemorrhage (RR 1.14, 95% CI 0.76-1.70), and any intracranial hemorrhage (RR 1.16, 95% CI 0.98-1.37) were similar in the IAT group and control group.</p><p><strong>Discussion: </strong>Among patients with AIS due to LVO, IAT after endovascular recanalization adds additional benefits to functional outcomes, with no increased risk of death or intracranial hemorrhage.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 3","pages":"e213842"},"PeriodicalIF":7.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should We Routinely Administer Intra-Arterial Thrombolysis After Endovascular Thrombectomy for Ischemic Stroke From Large Vessel Occlusion?","authors":"Timothy J England, Permesh Singh Dhillon","doi":"10.1212/WNL.0000000000213929","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213929","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 3","pages":"e213929"},"PeriodicalIF":7.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gestational Age at Birth and Clinical Manifestations of Spinal Muscular Atrophy.","authors":"Michelle Anne Farrar, Melissa Mandarakas, Nancy Briggs, Anita G Cairns, Karen Herbert, Zena Junek, Tejaswi Kandula, Jacqui Russell, Hugo Sampaio, Didu Kariyawasam","doi":"10.1212/WNL.0000000000213799","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213799","url":null,"abstract":"<p><strong>Background and objectives: </strong>Enhanced efficacy with spinal muscular atrophy (SMA) treatments is demonstrated with earlier initiation, ideally before the onset of symptoms. High-quality pregnancy and postnatal care for mother-baby dyads with SMA are important to ensure optimal outcomes. The aim of this study was to investigate obstetric and postnatal factors that could modify clinical outcomes of mother-baby dyads with SMA.</p><p><strong>Methods: </strong>This is an Australian dual-center prospective cohort study of 42 consecutive mother-baby dyads with SMA (≤4 survival motor neuron 2 [<i>SMN2</i>] copies) identified through a statewide newborn screening program or prenatal testing for SMA from 2018 to 2025. Sociodemographic, clinical, and genetic data were collated. For the group with 2 <i>SMN2</i> copies, regression models examined differences in gestational age at birth with study outcomes at diagnostic assessment, including clinical manifestations of SMA, motor function scores assessed with the CHOP-INTEND scale, and compound muscle action potential (CMAP).</p><p><strong>Results: </strong>Forty-two mother-baby dyads participated (n = 1 with 1 <i>SMN2</i>; n = 21 with 2 <i>SMN2</i>, gestational age at birth 39.9 ± 1.8 weeks; n = 20 with 3 or 4 <i>SMN2</i>, gestational age at birth 39.4 ± 0.8 weeks). All neonates with 3 or 4 <i>SMN2</i> copies were clinically silent at diagnostic assessment while 7 of 21 (33.3%) with 2 <i>SMN2</i> copies had clinical manifestations of SMA (<i>p</i> = 0.009). In newborns with 2 <i>SMN2</i> copies, higher gestational age at birth was associated with clinical manifestations of SMA (odds ratio 4.37, 95% CI 1.19-16.12, <i>p</i> = 0.001) and lower motor function (CHOP-INTEND: β = -4.52, 95% CI -7.018 to -2.019, <i>p</i> = 0.001) and strongly correlated with lower CMAP (<i>R</i> = -0.800, <i>p</i> < 0.001). High medical acuity was common in the obstetric and postnatal care of mothers and babies with SMA, occurring in 12 of 42 (29.3%) and 8 of 41 (19.5%), respectively, and mostly in those with 1 or 2 <i>SMN2</i> copies.</p><p><strong>Discussion: </strong>Early detection and timely administration of treatments are imperative in managing the rapid and severe loss of motor function that can occur in neonates with SMA. A personalized obstetric health care approach, prenatal testing, and planning the timing of delivery and initiation of treatment for newborns with genetically diagnosed SMA may improve outcomes.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 2","pages":"e213799"},"PeriodicalIF":7.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching NeuroImage: Lateral Geniculate Body Necrosis Presenting as Bilateral Acute Painless Vision Loss in a Case of Acute Pancreatitis.","authors":"Rahul Karthik Lingutla, Kishore Kalya Vyasaraj, Vikhyath Shetty Y","doi":"10.1212/WNL.0000000000213778","DOIUrl":"10.1212/WNL.0000000000213778","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 2","pages":"e213778"},"PeriodicalIF":7.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching NeuroImage: Clinicoradiologic Clues in Aceruloplasminemia.","authors":"Nikolai Gil D Reyes, Priti Gros, Paula Alcaide-Leon, Anthony E Lang, Gabor G Kovacs","doi":"10.1212/WNL.0000000000213820","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213820","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 2","pages":"e213820"},"PeriodicalIF":7.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Reasoning: Episodes of Uncontrollable Crying in a 52-Year-Old Man With a Sphenopetroclival Tumor.","authors":"Zeynep Özdemir, Stjepana Kovac, Walter Stummer, Michael Müther","doi":"10.1212/WNL.0000000000213847","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213847","url":null,"abstract":"<p><p>A 52-year-old man presented with progressive gait disturbances. MRI demonstrated a large extra-axial tumor in the cerebellopontine angle compressing the brainstem and resulting in hydrocephalus. While taking the patient's history, episodes of uncontrollable crying with sudden onset occurred multiple times. In this case report, we present and discuss the differential diagnoses of episodes of uncontrollable crying without emotional affect in adults and the possible underlying etiology.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 2","pages":"e213847"},"PeriodicalIF":7.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Muscular Atrophy Functional Composite Score Revised (SMA-FCR) in Untreated and Nusinersen-Treated Patient Cohorts.","authors":"Amy Pasternak, Michael P McDermott, Jacqueline Montes, Allan M Glanzman, Giorgia Coratti, Sally Dunaway Young, Trinh Tina Duong, William B Martens, John W Day, Zarazuela Zolkipli-Cunningham, Valeria Ada Sansone, Adele D'Amico, Sonia Messina, Claudio Bruno, Eugenio Mercuri, Darryl C De Vivo, Basil T Darras","doi":"10.1212/WNL.0000000000213839","DOIUrl":"10.1212/WNL.0000000000213839","url":null,"abstract":"<p><strong>Background and objectives: </strong>The Spinal Muscular Atrophy Functional Composite (SMA-FC) combines scores from the Hammersmith Functional Motor Scale Expanded (HFMSE), Upper Limb Module (ULM), and Six-Minute Walk Test (6MWT) into a single score and removes the floor and ceiling effects of the HFMSE. Our objective was to evaluate a revised version of the SMA-FC (SMA-FCR) by including the Revised ULM (RULM) in untreated and nusinersen-treated SMA.</p><p><strong>Methods: </strong>We included participants with HFMSE, RULM, and 6MWT data at the same visit. The SMA-FCR represented the average of the 3 test scores, each expressed as the percentage of the maximum possible score (HFMSE and RULM) or the percent of predicted normative performance (6MWT). Mean annual rates of change were calculated in participants who had SMA-FCR data at 2 or more visits while untreated and/or while treated.</p><p><strong>Results: </strong>There were 580 participants (49.6% female) with a mean (SD) age of 19.2 (15.5) years (range 1.3-70.6 years). The median (interquartile range) SMA-FCR scores were 3.6 (0.0-8.1) for nonsitters, 22.3 (16.3-31.2) for sitters, and 75.1 (63.7-86.6) for walkers. The SMA-FCR score reduced the ceiling effect seen with the RULM in walkers and the floor effect seen with the HFMSE in nonsitters. The mean annual rate of change in the SMA-FCR was -0.62 (95% CI -1.15 to -0.08, <i>p</i> = 0.02) in untreated participants and 0.15 (95% CI -0.12 to 0.42, <i>p</i> = 0.28) in treated participants (difference = 0.77, 95% CI 0.19-1.34, <i>p</i> = 0.009). The mean annual rate of change in the HFMSE was -0.19 (95% CI -0.63 to 0.25, <i>p</i> = 0.40) in untreated participants and -0.21 (95% CI -0.43 to 0.01, <i>p</i> = 0.06) in treated participants (difference = -0.02, 95% CI -0.49 to 0.46, <i>p</i> = 0.94).</p><p><strong>Discussion: </strong>The SMA-FCR broadens the spectrum of abilities captured in SMA. Analyses of the treated-untreated differences in mean annual rate of change suggest that the SMA-FCR may be more sensitive to change than the HFMSE. The use of the SMA-FCR in clinical trials might allow for study designs with broader eligibility criteria including weaker individuals who score minimally on the HFMSE and stronger individuals who score maximally on the RULM.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 2","pages":"e213839"},"PeriodicalIF":7.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statin Initiation and Dementia Incidence in a Large Health Care System From 1997 to 2020: A Target Trial Emulation Study.","authors":"Scott C Zimmerman, Minhyuk Choi, Chen Jiang, Erin L Ferguson, Thomas J Hoffmann, Kaitlin Swinnerton, Akinyemi Oni-Orisan, Paola Gilsanz, Travis J Meyers, Vidhu Choudhary, Rachel A Whitmer, Neil Risch, Ronald M Krauss, Catherine A Schaefer, M Maria Glymour","doi":"10.1212/WNL.0000000000213855","DOIUrl":"10.1212/WNL.0000000000213855","url":null,"abstract":"<p><strong>Background and objectives: </strong>Previous research of associations between statins and Alzheimer disease and Alzheimer disease-related dementias (AD/ADRDs) has been limited by short follow-up, small samples, and confounding. We aimed to estimate the association between the 1st statin prescription and incident AD/ADRD among members of a large population-based cohort of older adults.</p><p><strong>Methods: </strong>We used a cohort study design emulating a target trial using data from Kaiser Permanente Northern California (KPNC), an integrated health care delivery system. Participants were born before 1951 and KPNC members for 4+ years during 1997-2010. Embedded subsamples included sociodemographic and genetic data. Statin initiators were matched at first prescription (\"baseline\") with up to 5 \"noninitiators\" based on age and low-density lipoprotein cholesterol (LDL-C). Participants with extreme propensity scores were excluded. The outcome was time to incident AD/ADRD diagnosis, censoring, or the administrative end of study (December 31, 2020). Cox proportional hazard models were used to estimate hazard ratios for statin initiation on AD/ADRD incidence. Follow-up time was divided at the first year of follow-up to account for increased AD/ADRD detection in the first year due to increased interaction with the health care system after a statin prescription.</p><p><strong>Results: </strong>Among eligible participants (n = 705,061), 264,294 individuals (37.5% of eligible participants) initiated any statin during 2001-2010 (\"initiators\"), of whom 249,613 (94.4%) were matched with 255,937 unique noninitiators to create the analytic sample (322,358 unique participants; mean age at baseline = 67.4 years; 55.1% female). The average follow-up was 11.8 years. In the first year after initiating statins, AD/ADRD diagnoses were elevated by 46% (hazard ratio [HR] = 1.46, 95% CI 1.42-1.53) compared with noninitiators. After 1 year, statin initiators experienced no difference in AD/ADRD incidence (full sample: HR = 1.00, 95% CI 0.99-1.01; subsample with survey covariates: HR = 1.01, 95% CI 0.98-1.06; subsample with survey and genetic covariates: HR = 0.97, 95% CI 0.91-1.07). Adjustment for sociodemographic covariates and <i>apolipoprotein E e4</i> allele count did not materially change the findings.</p><p><strong>Discussion: </strong>In this large emulated target trial, statin initiation was inconsistent with more than a 3% increase or decrease in the hazard of AD/ADRD after the first year of follow-up. This intent-to-treat analysis does not directly quantify effects of long-term exposure to statins. Associations in the first year likely reflect increased medical observation immediately after statin initiation.</p><p><strong>Classification of evidence: </strong>This emulated trial provides Class II evidence that statin initiation is not associated with AD/ADRD or AD incidence after the first year of follow-up.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 2","pages":"e213855"},"PeriodicalIF":7.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Progression of Infantile Spinal Muscular Atrophy: Why Gestational Age Matters.","authors":"Madeline Aldridge, Charlotte J Sumner","doi":"10.1212/WNL.0000000000213923","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213923","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 2","pages":"e213923"},"PeriodicalIF":7.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General vs Nongeneral Anesthesia for Endovascular Thrombectomy in Patients With Large Core Strokes: A Prespecified Secondary Analysis of SELECT2 Trial.","authors":"Amrou Sarraj, Spiros Blackburn, Michael G Abraham, Muhammad S Hussain, Santiago Ortega-Gutierrez, Michael Chen, Scott E Kasner, Leonid Churilov, Clark W Sitton, Deep K Pujara, Sophia Sundararajan, Yin C Hu, Nabeel A Herial, Ronald F Budzik, William J Hicks, Nirav Vora, Juan F Arenillas, Mercedes De Lara Alfonso, Maria E Ramos Araque, Jenny P Tsai, Mohammed A Abdulrazzak, Osman Kozak, Bernard Yan, Peter J Mitchell, Dennis J Cordato, Nathan W Manning, Andrew Cheung, Ricardo A Hanel, Amin N Aghaebrahim, Teddy Y Wu, Pere Cardona Portela, Andres J Paipa Merchán, Chirag D Gandhi, Fawaz Al-Mufti, Edgar A Samaniego, Laith Maali, Abed Qureshi, Colleen G Lechtenberg, Sabreena Slavin, Lee Rosterman, Daniel Gibson, Adam N Wallace, Daniel Sahlein, Natalia Pérez de la Ossa, Maria Hernández Pérez, Joanna D Schaafsma, Jordi Blasco, Arturo Renú, Navdeep Sangha, Steven Warach, Timothy J Kleinig, Michael Mullen, Lucas Elijovich, Faris Shaker, Faisal K Al-Shaibi, Hannah Johns, Kelsey R Duncan, Amanda Opaskar, Marc J Popovic, Michael Altose, Abhishek Ray, Wei Xiong, Jeffrey Sunshine, Michael DeGeorgia, Thanh N Nguyen, Johanna T Fifi, Stavropoula Tjoumakaris, Pascal Jabbour, Vitor Mendes Pereira, Maarten G Lansberg, Greg W Albers, Cathy Sila, Nicholas Bambakidis, Stephen Davis, Lawrence Wechsler, Michael D Hill, James C Grotta, Marc Ribo, Ameer E Hassan, Bruce C Campbell","doi":"10.1212/WNL.0000000000213819","DOIUrl":"10.1212/WNL.0000000000213819","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objectives: &lt;/strong&gt;The association of anesthesia approach during endovascular thrombectomy (EVT) with clinical outcomes in large strokes is unexplored. We aimed to evaluate whether general anesthesia (GA), compared with non-GA, was associated with better functional outcomes in the SELECT2 trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In a prespecified secondary analysis of the SELECT2 trial that enrolled patients with large strokes on noncontrast CT (Alberta Stroke Program Early CT Score [ASPECTS] 3-5), CT perfusion/MRI (core volume ≥50 mL), or both, functional outcomes were compared in EVT-treated patients who received GA or non-GA and whether this association was modified by stroke severity (NIH Stroke Scale score), ischemic injury estimates, and collateral status was evaluated. The primary outcome was 90-day functional status (ordinal modified Rankin Scale [mRS]). Secondary outcomes were functional independence (mRS scores 0-2), independent ambulation (mRS scores 0-3), complete dependence or death (mRS scores 5-6), and mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 178 EVT patients (median [interquartile range] age 66 [58-75] years, stroke severity 19 [15-23], CT-ASPECTS 4 [3-5], and core volume 101.5 [70-138] mL, 71 women [39.9%]), 104 (58%) received GA. Time from randomization to arterial puncture was longer with GA (40 [23-59] minutes) vs non-GA (27 [18-47] minutes), but procedural duration (GA: 57 [31.5-77] minutes vs non-GA: 49.5 [30-71] minutes) was similar. Successful reperfusion (modified treatment in cerebral infarction [mTICI] score 2b-3) rates were similar (GA 81 (78%) vs non-GA 62 (84%), adjusted relative risk [aRR] 0.91, 95% CI 0.79-1.06). In addition, mRS distribution did not differ between GA and non-GA groups (adjusted generalized odds ratio 1.21, 95% CI 0.86-1.70), as well as independent ambulation (GA: 41% vs non-GA: 34%, aRR 1.22, 95% CI 0.86-1.74) and functional independence (GA: 22% vs non-GA: 18%, aRR 1.32, 95% CI 0.75-2.35). Stroke severity, ASPECTS, ischemic core volume, or collaterals did not modify the association between anesthesia and functional outcome (all &lt;i&gt;p&lt;/i&gt;-interaction &gt;0.05). Patients experienced systolic blood pressure (SBP) variability ≥40 mm Hg and minimum intraprocedural SBP (&lt;100 mm Hg) more frequently with GA, but this did not modify GA association with functional outcomes (&lt;i&gt;p&lt;/i&gt;-interaction = 0.77 and 0.89, respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;In patients with large core strokes randomized in SELECT2, EVT outcomes did not differ significantly based on anesthesia approach (GA or non-GA) without heterogeneity across stroke severity and size. While GA was associated with higher SBP variability and lower minimum SBP, this did not modify GA association with functional outcomes. While allocation to anesthesia approach was nonrandomized, our findings suggest that optimizing institutional protocols for preferred anesthesia technique, whether GA or non-GA, may enhance EVT","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 2","pages":"e213819"},"PeriodicalIF":7.7,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}