Episode 403: 411. Gabapentin and Emergency Carotid Artery Stenting in Stroke

Study Summary: Emergent Carotid Stenting in Acute Stroke Thrombectomy

A multicenter registry study in Catalonia (2017–2023) evaluated outcomes in 578 patients with acute ischemic stroke and tandem lesions (large-vessel occlusion plus extracranial carotid stenosis). Patients were divided into two groups: those who received emergent carotid artery stenting (E-CAS) and those who did not (non-CAS).

Key Findings:

• Favorable outcomes (modified Rankin Scale 0–2) were more common in the E-CAS group at:
  • 90 days: 46% vs. 37%
  • 1 year: Odds ratio 1.35
• Recanalization rates were higher with E-CAS: 92% vs. 73%
• No significant differences in:
  • Hemorrhagic transformation at 36 hours (though a trend toward higher rates with E-CAS)
  • 1-year mortality

Conclusion:

Emergent carotid stenting during thrombectomy may improve functional outcomes and recanalization without significantly increasing bleeding or mortality. However, as this was not a randomized trial, results should be interpreted cautiously. Further randomized studies are needed.

Ezcurra-Díaz G et al. Emergent carotid artery stenting in patients with acute ischemic stroke with tandem lesions: One-year follow-up results from the SECURIS study. Neurology 2025 Oct 7; 105:e214067.

Gabapentinoids for Postoperative Pain: No Benefit Found

Study Overview: A large randomized, placebo-controlled trial in the U.K. (GAP study) evaluated the effectiveness of gabapentin for postoperative pain in 1,200 patients undergoing various cardiac, thoracic, and abdominal surgeries.

Intervention:

• Gabapentin group: 600 mg pre-op, then 300 mg twice daily for 2 days post-op
• Control group: Placebo

Key Findings:

• Slight pain reduction at 1 hour post-op (4.0 vs. 3.5 on 11-point scale)
• No difference in pain at later time points
• No differences in:
  • Opioid use
  • Serious adverse events
  • Length of hospital stay

Commentary: Despite widespread off-label use, this large, well-designed trial found no meaningful benefit of gabapentin for postoperative pain. While short-term use appeared safe, prolonged use may pose risks (e.g., sedation, falls, respiratory depression). Clinicians are advised to reconsider routine perioperative use of gabapentinoids.

Baos S et al. Gabapentin for pain management after major surgery: A placebo-controlled, double-blinded, randomized clinical trial (the GAP study). Anesthesiology 2025 Oct; 143:851.