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StrokePhase 4SEGANCT03263117

SEdation Versus General Anesthesia for Endovascular Therapy in Acute Ischemic Stroke

A Phase 4 study testing Sedation, General Anesthesia (GA) and Intra-arterial Thrombectomy in people with Stroke, run by The University of Texas Health Science Center, Houston at 11 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Objectives: This study aims to estimate overall treatment benefit (improvement in disability) among acute ischemic stroke patients that are randomized to General Anesthesia (GA) compared with Sedation (CS) during endovascular therapy. Read more about this study

Who is it for?
Ages 18 to 90 years
Conditions the study is for
Stroke
What is being tested?
Sedation, General Anesthesia (GA) and Intra-arterial Thrombectomy
Could I receive a placebo?
No, everyone receives an active treatment
How many people
260 participants
Where
11 sitesUnited States
Study dates
1 Jul 2018to 22 Apr 2023
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Acute ischemic stroke due to large intracranial vessel occlusion demonstrated on CT-angiography in the following anterior circulation locations that will be treated by endovascular therapy (EVT):
  • Internal Carotid Artery (terminal "T" or "L-type"- occlusion)
  • Middle Cerebral Artery (MCA) M1 or proximal M2
  • Anterior Cerebral Artery (ACA) A1 or proximal A2
  • Patients who receive IV-tPA thrombolysis are eligible provided the drug was delivered within 4.5 hours of stroke onset or last seen normal and in accordance with local hospital standard of care.
  • Ages 18-90.
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  • National Institute of Health Stroke Scale (NIHSS) score 6-30
  • Time of from stroke symptom onset of last seen normal to start of EVT (defined as groin puncture) ≤ 16 hours.
  • Limited infarct core, as defined below and adapted from the 2018 American Heart Association guidelines
  • For patients presenting ≤ 6 hours from time of symptom onset or last seen normal, Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥ 6
  • For patients presenting > 6 hours and ≤ 16 hours from time of symptom onset or last seen normal, they must satisfy EITHER ONE of the two following criteria:
  • Ischemic core by CT Perfusion or MRI/MR Perfusion < 70 mL, a ratio of volume of penumbral tissue to infarct core of ≥ 1.8, and and absolute volume of penumbral tissue of ≥ 15 mL OR ii. For patients with NIHSS ≥ 10, infarct core of < 31 mL by CT Perfusion or MRI; For patients with NIHSS ≥ 20, infarct core < 51 mL.
  • Subject willing/able to return for protocol required follow up visits.
  • No significant pre-stroke disability (modified Rankin Score must be ≤ 2).
  • Females of childbearing potential must have a negative serum or urine pregnancy test.
  • Patient or patient's legally authorized representative has given Informed Consent according to Good Clinical Practices (GCP) and/or local IRB policies.

Who cannot join

  • Coma on admission (Glasgow Coma Scale <8), need for intubation upon ED arrival, or transferred patients who present previously intubated.
  • Severe agitation or seizures on admission that preclude safe vascular access.
  • Loss of airway protective reflexes and/or vomiting on admission.
  • Predicted or known difficult airway.
  • Pre-existing neurological or psychiatric disease that would confound the neurological or functional evaluations, e.g. dementia.
  • Presumed septic embolus, or suspicion of bacterial endocarditis
Show all 10Show fewer
  • Currently participating or has participated in any investigational drug or device study within 30 days.
  • Inability to follow-up for 90-day assessment.
  • Known history of allergy to anesthesia drugs.
  • Known history or family history of malignant hyperthermia

Trial locations and contacts

11 sites in 1 country.

11 sites in 1 country

United States11 sites
  • Geisinger Health

    Danville, Pennsylvania, 17822

  • Memorial Hermann Hospital System - Memorial City Medical Center

    Houston, Texas, 77024

  • Baylor College of Medicine

    Houston, Texas, 77030

  • University of Texas Health Science Center Houston with Memorial Hermann Hospital System - The Medical Center

    Houston, Texas, 77030

  • Indiana University College of Medicine

    Indianapolis, Indiana, 46202

  • University of Iowa Hospitals and Clinics

    Iowa City, Iowa, 52242

  • Henry Ford Health System

    Louisville, Kentucky, 48150

  • Temple University

    Philadelphia, Pennsylvania, 19122

  • Rochester Regional Health

    Rochester, New York, 14617

  • Memorial Hermann Hospital System - The Woodlands Medical Center

    The Woodlands, Texas, 77380

  • Wake Forest Baptist Health

    Winston-Salem, North Carolina, 27157

Other trials in United States

About this study

Official title: SEGA - SEdation Versus General Anesthesia for Endovascular Therapy in Acute Ischemic Stroke - a Randomized Comparative Effectiveness Trial.

Objectives:

This study aims to estimate overall treatment benefit (improvement in disability) among acute ischemic stroke patients that are randomized to General Anesthesia (GA) compared with Sedation (CS) during endovascular therapy. Assess safety (as measured by incidence of symptomatic intracranial hemorrhage); rates of Endovascular therapy (EVT) procedural complications, reperfusion; and quality of life.

Hypothesis:

GA during EVT for acute ischemic stroke improves functional outcomes at 90 days compared to sedation.

Conditions
Stroke
Being tested
Sedation, General Anesthesia (GA), Intra-arterial Thrombectomy
Keywords
Acute stroke, Cerebral Stroke
Medical subject headings
Stroke

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • SedationDrug

    The protocol does not specify a particular combination of drugs that must be used for sedation.

    The most common drugs utilized for sedation and wide dosing ranges are included in the protocol (i.e., sedation will be provided under the supervision of an anesthesiologist and may use a combination of fentanyl, midazolam, dexmedetomidine infusion (with or without loading dose), and/or low-dose propofol by intermittent bolus or infusion); however, the choice of specific drugs and dosages for achieving conscious sedation or general anesthesia will not be specified by the protocol but will be up to the anesthesiologist.

  • General Anesthesia (GA)Drug

    The protocol doesn't specify drugs that must be used for GA, the choice of drugs and dosages for achieving general anesthesia will not be specified by the protocol but will be up to the anesthesiologist.

    The most common drugs utilized for GA and wide dosing ranges included in the protocol are (GA will be provided under the supervision of an anesthesiologist and induction of anesthesia may be achieved with propofol and/or etomidate; muscle paralysis may be achieved with succinylcholine or non-depolarizing paralytic (rocuronium or vecuronium); and adjuvant lidocaine and fentanyl; if intravenous maintenance of anesthesia is used, it may be achieved by propofol infusion at 50 to 150 mcg/kg/min with redosing of non-depolarizing paralytic and fentanyl as needed; if inhalational maintenance of anesthesia is used it will be achieved with sevoflurane 1% to 2% or desflurane 3% to 6% end-tidal concentration with redosing of non-depolarizing paralytic and fentanyl as needed)

  • Intra-arterial ThrombectomyProcedure or surgery

    Also called Endovascular Therapy

    The first line therapeutic embolectomy device should be a stent retriever. Additional Endovascular therapies including, but not limited to, intra- or extracranial angioplasty ± stenting; antithrombotics (oral, IV or IA antiplatelets or anticoagulants) intra-arterial thrombolytics; are left to the decision of the local treatment team.

Study groups in NCT03263117
Study groupRoleWhat they receive
SedationActive comparatorThe protocol does not specify a particular combination of drugs that must be used for sedation. The choice of specific drugs and dosages for achieving sedation will be up to the anesthesiologist.
Receives: Drug: Sedation; Procedure: Intra-arterial Thrombectomy
General AnesthesiaActive comparatorThe protocol does not specify a particular combination of drugs that must be used for general anesthesia. The choice of specific drugs and dosages for achieving general anesthesia will be up to the anesthesiologist.
Receives: Drug: General Anesthesia (GA); Procedure: Intra-arterial Thrombectomy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Modified Ordinal Rankin Scale (mRS)

    mRS ranges from 0 to 6, with higher scores indicating greater disability. 6 categories are reported: number of participants who had a score of 0, 1, 2, 3, or 4 will be reported separately as 5 categories, and those who had a score of 5 or 6 will be combined and reported as a single category.

    0: no symptoms/normal (physical, cognitive etc.)

    1. no significant disability despite symptoms; able to carry out all usual duties and activities
    2. slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance
    3. moderate disability; requiring some help, but able to walk without assistance from another individual (use of walking aids alone is not counted as assistance)
    4. moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance
    5. severe disability; bedridden, incontinent and requiring constant nursing care and attention
    6. dead

    Measured: 90 days

Secondary outcomes (8)
  1. Dichotomized Modified Ordinal Rankin Scale (mRS)

    The modified Rankin Scale (mRS) ranges from 0 to 6, with higher scores indicating greater disability and where 0-2 is generally considered a good outcome with individuals assuming complete functional independence. 2 categories are reported: number of participants who had a score of 0-2, and number who had a score of 3-6.

    0: no symptoms/normal (physical, cognitive etc.)

    1. no significant disability despite symptoms; able to carry out all usual duties and activities
    2. slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance
    3. moderate disability; requiring some help, but able to walk without assistance from another individual (use of walking aids alone is not counted as assistance)
    4. moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance
    5. severe disability; bedridden, incontinent and requiring constant nursing care and attention
    6. dead

    Measured: 90 days

  2. Number of Participants With Angiographic Reperfusion Defined as Modified a TICI Score of ≥ 2b

    The thrombolysis in cerebral infarction (TICI) grading system is a tool for determining the response of thrombolytic therapy for ischemic stroke. The TICI grade ranges from 0 to 3, with a higher score indicating greater perfusion.

    grade 0: no perfusion grade 1: penetration with minimal perfusion grade 2: partial perfusion grade 2A: only partial filling (less than two-thirds) of the entire vascular territory is visualized grade 2B: complete filling of all of the expected vascular territory is visualized but the filling is slower than normal grade 3: complete perfusion

    Measured: post procedure within 6 hours

  3. Score on the National Institutes of Health Stroke Scale, or NIH Stroke Scale (NIHSS)

    The National Institutes of Health Stroke Scale (NIHSS) is a tool used objectively quantify the impairment caused by a stroke. Total score ranges from 0 - 42, with a higher score indicating greater severity of impairment caused by stroke.

    0 No stroke symptoms 1-4 Minor stroke 5-15 Moderate stroke 16-20 Moderate to severe stroke 21-42 Severe stroke

    Measured: 24-36 hours post procedure

  4. Number of Participants With Functional Independence as Indicated by an mRS Score of 0, 1, or 2

    The modified Rankin Scale (mRS) ranges from 0 to 6, with higher scores indicating greater disability and where 0-2 is generally considered a good outcome with individuals assuming complete functional independence.

    0: no symptoms/normal (physical, cognitive etc.)

    1. no significant disability despite symptoms; able to carry out all usual duties and activities
    2. slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance
    3. moderate disability; requiring some help, but able to walk without assistance from another individual (use of walking aids alone is not counted as assistance)
    4. moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance
    5. severe disability; bedridden, incontinent and requiring constant nursing care and attention
    6. dead

    Measured: 90 days

  5. Quality of Life as Assessed by the European Quality of Life (EuroQol) 5 Dimensions 5 Level Version (EQ-5D-5L) Assessment

    The EQ-5D-5L score ranges from -0.59 to 1, where 1 is the best possible health state. Negative values represent health states perceived as worse than dead, which is equal to 0.

    Measured: 90 days

  6. Number of Participants With Symptomatic Intracerebral Hemorrhage

    Symptomatic intracerebral hemorrhage was defined using the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) definition, a ≥ 4 point increase in NIHSS score with a parenchymal hemorrhage type 2 within 36 hours.

    Measured: 18-36 hours post procedure

  7. Number of Participants With All-cause Mortality

    Measured: 18-36 hours post procedure

  8. Number of Participants With Procedural Complications

    Measured: 18-36 hours post procedure

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Aug 2017
  2. Study start1 Jul 2018
  3. Primary completion22 Apr 2023
  4. Study completion22 Apr 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
260 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03263117
Sponsor's protocol ID
HSC-MS-17-0436
Acronym
SEGA
Status last verified
Sep 2025
First submitted
16 Aug 2017
Last updated
26 Nov 2025
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Chen PR, Artime CA, Sheth SA, Pedroza C, Ortega-Gutierrez S, Wolfe S, Sitton C, Kan P, Tanweer O, Chebl A, Schirmer CM, Morrow JT, Alderazi YJ, Bohnstedt B, Erkmen K, Samaniego EA, Garrido E, Savitz SI, Engstrom A, Aguilar E, Nguyen T, Barreto AD; SEGA Investigators. Sedation vs General Anesthesia for Endovascular Therapy in Acute Ischemic Stroke: The SEGA Randomized Clinical Trial. JAMA Neurol. 2025 Dec 1;82(12):1265-1273. doi: 10.1001/jamaneurol.2025.3775.

    PubMed 41082222
  • Tosello R, Riera R, Tosello G, Clezar CN, Amorim JE, Vasconcelos V, Joao BB, Flumignan RL. Type of anaesthesia for acute ischaemic stroke endovascular treatment. Cochrane Database Syst Rev. 2022 Jul 20;7(7):CD013690. doi: 10.1002/14651858.CD013690.pub2.

    PubMed 35857365

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Sedation, General Anesthesia (GA) and Intra-arterial Thrombectomy in people with Stroke, run by The University of Texas Health Science Center, Houston at 11 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 16 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 26 Nov 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 11 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 5 Sep 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Modified Ordinal Rankin Scale (mRS) (time frame: 90 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03263117, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Nov 2025.

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