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Purpose <p>This systematic review and meta-analysis aimed to compare general anesthesia (GA) versus non-GA effects on clinical and procedural outcomes during endovascular therapy (EVT) for posterior circulation stroke.</p> Methods <p>Following PRISMA 2020, we systematically searched PubMed, Cochrane, Web of Science, Scopus, Embase until June-2025 for comparative studies on GA vs. non-GA in posterior circulation EVT. Data on 90-day mortality, intracranial hemorrhage (any, aICH; symptomatic, sICH), functional independence (modified Rankin Scale [mRS] 0‑2/0-3), and successful recanalization (mTICI&#xa0;2b-3) were extracted.</p> Results <p>Fourteen studies, 3899 patients (1950 GA, 1949 non-GA) were included. No significant differences between GA and non-GA were found for 90-day all-cause mortality (OR 1.23; 95% CI: 0.92–1.63), aICH (OR 0.72; 95% CI: 0.45–1.14), sICH (OR 0.79; 95% CI: 0.58–1.06), or functional independence. However, GA significantly increased the odds of successful recanalization (mTICI&#xa0;2b-3) (OR 1.24; 95% CI: 1.01–1.52; <i>p</i> = 0.0389).</p> Conclusion <p>In posterior circulation EVT, GA enhances mTICI&#xa0;2b‑3 but offers no demonstrable clinical advantage or disadvantage over non-GA for mortality, aICH sICH, or functional independence. An individualized anesthetic approach, balancing procedural stability against physiological risks, is advised. Future randomized trials with optimized physiological management are crucial to align technical and clinical gains.</p>

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General Versus Non-General Anesthesia in Endovascular Treatment for Posterior Circulation Stroke: a Systematic Review and Meta-analysis

  • 期刊论文

  • 发表日期：

    2026年2月26日

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  • Lucca Tamara Alves Carretta,
  • Rudolfh Batista Arend,
  • Henrique Padilha Gnoatto,
  • Victor Luiz Ferreira Kauer,
  • Bruna Lara Zardin,
  • Filipe Virgilio Ribeiro,
  • Mariana Letícia de Bastos Maximiano,
  • Anderson Silva Corin,
  • Nicole Baptista de Oliveira,
  • Tassiane Cristina Morais,
  • Fernando Rocha Oliveira,
  • Leandro de Assis Barbosa,
  • Alex Roman,
  • Hasan T. Ozgur,
  • Ahmet Günkan

摘要

Purpose

This systematic review and meta-analysis aimed to compare general anesthesia (GA) versus non-GA effects on clinical and procedural outcomes during endovascular therapy (EVT) for posterior circulation stroke.

Methods

Following PRISMA 2020, we systematically searched PubMed, Cochrane, Web of Science, Scopus, Embase until June-2025 for comparative studies on GA vs. non-GA in posterior circulation EVT. Data on 90-day mortality, intracranial hemorrhage (any, aICH; symptomatic, sICH), functional independence (modified Rankin Scale [mRS] 0‑2/0-3), and successful recanalization (mTICI 2b-3) were extracted.

Results

Fourteen studies, 3899 patients (1950 GA, 1949 non-GA) were included. No significant differences between GA and non-GA were found for 90-day all-cause mortality (OR 1.23; 95% CI: 0.92–1.63), aICH (OR 0.72; 95% CI: 0.45–1.14), sICH (OR 0.79; 95% CI: 0.58–1.06), or functional independence. However, GA significantly increased the odds of successful recanalization (mTICI 2b-3) (OR 1.24; 95% CI: 1.01–1.52; p = 0.0389).

Conclusion

In posterior circulation EVT, GA enhances mTICI 2b‑3 but offers no demonstrable clinical advantage or disadvantage over non-GA for mortality, aICH sICH, or functional independence. An individualized anesthetic approach, balancing procedural stability against physiological risks, is advised. Future randomized trials with optimized physiological management are crucial to align technical and clinical gains.