Anesthesia and thrombectomy: updated meta-analysis of randomized controlled trials

Area of Science:

• Neurology
• Interventional Cardiology
• Anesthesiology

Background:

• Emergent large vessel occlusion (ELVO) stroke treatment involves endovascular thrombectomy (EVT).
• Anesthesia choice, general anesthesia (GA) versus non-GA sedation, is debated for EVT.
• Previous studies include 10 randomized controlled trials (RCTs) comparing GA and non-GA for EVT in ELVO patients.

Purpose of the Study:

• To perform an updated meta-analysis of existing RCTs comparing GA and non-GA for EVT in ELVO.
• To evaluate the impact of anesthesia choice on revascularization rates and functional outcomes.

Main Methods:

• Systematic review and meta-analysis following PRISMA guidelines.
• Included RCTs comparing GA vs. non-GA during EVT for ELVO, published between May 2022 and October 2025.
• Two analyses were conducted: primary (all 10 trials) and secondary (6 trials with criteria similar to pivotal thrombectomy trials).

Main Results:

• Across 10 trials (n=1584), GA significantly increased successful revascularization (OR 1.79, P<0.001).
• No significant difference in functional independence was observed in the primary analysis.
• In the secondary analysis (n=648), GA significantly improved functional independence (OR 1.58, P=0.005) and revascularization rates.
• No significant differences in 90-day mortality or hemorrhagic complications between groups.

Conclusions:

• General anesthesia (GA) significantly improves successful revascularization rates in EVT for ELVO.
• In trials with strict EVT inclusion criteria, GA use was associated with significantly better functional outcomes at 90 days.
• Anesthesia choice may play a crucial role in optimizing EVT outcomes for specific patient populations.