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Purpose <p>With the expanding use of endovascular thrombectomy (EVT) for distal and medium vessel occlusions (DMVOs), evaluating how anesthesia type affects clinical outcomes is essential. This meta-analysis compared outcomes between general anesthesia (GA) and non-GA in patients undergoing EVT for DMVOs.</p> Methods <p>We systematically searched PubMed, Embase, Cochrane Library, and Web of Science for eligible studies. Primary outcomes included successful reperfusion, 90-day mortality, excellent functional outcome (Modified Rankin Scale [mRS] 0–1), and symptomatic intracranial hemorrhage (sICH). Risk ratios (RR) with 95% confidence intervals (CI) were calculated using the Mantel-Haenszel method and a&#xa0;random-effects model. Heterogeneity was assessed with&#xa0;I<sup>2</sup> and Cochran’s&#xa0;Q test.</p> Results <p>Five studies comprising 1643 patients were included. There was no significant difference in successful reperfusion between GA and non-GA groups (RR 1.01; 95% CI 0.94–1.08; I<sup>2</sup> = 32.3%). However, GA was associated with significantly higher 90-day mortality (RR 1.55; 95% CI 1.23–1.96; I<sup>2</sup> = 0%). Excellent functional outcomes (mRS 0–1 at 90&#xa0;days) were similar between groups (RR 0.92; 95% CI 0.78–1.10; I<sup>2</sup> = 24.2%). No statistically significant difference in sICH was observed between the GA and non-GA groups (RR 2.61; 95% CI 0.99–6.86; I<sup>2</sup> = 40.8%). However, the leave-one-out analysis revealed a&#xa0;significant association indicating a&#xa0;higher risk of sICH with GA (RR 3.88; 95% CI 1.79–8.41; I<sup>2</sup> = 0%).</p> Conclusion <p>GA was linked to increased 90-day mortality in EVT for DMVOs, with no differences in reperfusion or functional recovery. A&#xa0;possible higher risk of sICH was noted. Further prospective studies are needed to guide anesthetic strategy.</p>

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General Versus Non-General Anesthesia in Endovascular Thrombectomy for Distal/Medium Vessel Occlusions: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2025年11月25日

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  • Luiz Guilherme Silva Almeida,
  • Ocílio Ribeiro Gonçalves,
  • Mariana Lee Han,
  • Yasmin Picanço Silva,
  • Lucca Tamara Alves Carretta,
  • Marcelo Costa,
  • Paweł Łajczak,
  • Luiz Felipe Simões Antunes Nery dos Santos,
  • Rafael Torres Fonseca dos Santos,
  • Ahmet Günkan,
  • Pascal Jabbour

摘要

Purpose

With the expanding use of endovascular thrombectomy (EVT) for distal and medium vessel occlusions (DMVOs), evaluating how anesthesia type affects clinical outcomes is essential. This meta-analysis compared outcomes between general anesthesia (GA) and non-GA in patients undergoing EVT for DMVOs.

Methods

We systematically searched PubMed, Embase, Cochrane Library, and Web of Science for eligible studies. Primary outcomes included successful reperfusion, 90-day mortality, excellent functional outcome (Modified Rankin Scale [mRS] 0–1), and symptomatic intracranial hemorrhage (sICH). Risk ratios (RR) with 95% confidence intervals (CI) were calculated using the Mantel-Haenszel method and a random-effects model. Heterogeneity was assessed with I2 and Cochran’s Q test.

Results

Five studies comprising 1643 patients were included. There was no significant difference in successful reperfusion between GA and non-GA groups (RR 1.01; 95% CI 0.94–1.08; I2 = 32.3%). However, GA was associated with significantly higher 90-day mortality (RR 1.55; 95% CI 1.23–1.96; I2 = 0%). Excellent functional outcomes (mRS 0–1 at 90 days) were similar between groups (RR 0.92; 95% CI 0.78–1.10; I2 = 24.2%). No statistically significant difference in sICH was observed between the GA and non-GA groups (RR 2.61; 95% CI 0.99–6.86; I2 = 40.8%). However, the leave-one-out analysis revealed a significant association indicating a higher risk of sICH with GA (RR 3.88; 95% CI 1.79–8.41; I2 = 0%).

Conclusion

GA was linked to increased 90-day mortality in EVT for DMVOs, with no differences in reperfusion or functional recovery. A possible higher risk of sICH was noted. Further prospective studies are needed to guide anesthetic strategy.