Anesthetic reporting in stroke thrombectomy randomized clinical trials: a systematic review

This systematic review elucidates the level of detail of anesthesia care in randomized clinical trials (RCTs) of mechanical thrombectomy (MT) for acute ischemic stroke (AIS). RCTs between January 1, 2004, and December 31, 2024, were searched and reviewed. A scoring system for individual trial elements was developed and reported, categorized as demographic (n = 9), essential monitoring (n = 13), anesthetic care (n = 13), and MT outcomes (n = 5). The elements were reported as median [Q1; Q3] and compared before and after the 2014 Society for Neuroscience in Anesthesiology and Critical Care (SNACC) guidelines for endovascular thrombectomy were published. This study was registered on the International Prospective Register of Systematic Reviews on January 19, 2025. A total of 77 studies (25 enrolling patients before the SNACC guidelines and 52 enrolling afterwards) were included. The reporting of trial elements were: demographics (7 of 9 elements, 77.8 % [Q1:Q3: 77.8 %;88.9 %], essential monitoring (0 of 13 elements, 0 % [Q1:Q3: 0 %;8%], anesthesia (0 of 13 elements, 0 % [Q1:Q3: 0 %;8%]), and outcomes (3 of 5 elements, 60 % [Q1:Q3: 60 %;80 %]). When an anesthesiologist was included as an author, there was a significant improvement for the essential monitoring score (42 % vs. 0 %, p = 0.03) and the anesthesia score (42 % vs. 0 %, p = 0.0096), and in the anesthesia score in single-center studies (15 % vs. 0 %, p = 0.0024). Anesthesia and physiologic details are rarely included in the MT-related RCTs for AIS; therefore, future RCTs should include anesthesia-related details.