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

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.

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.

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).

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.