Comparison of Volatile Anesthesia and Intravenous Anesthesia for Endovascular Thrombectomy in Acute Ischemic Stroke...

Endovascular thrombectomy (EVT) is a well-established treatment for acute ischemic stroke (AIS). However, the optimal choice of general anesthesia (GA) during this procedure remains uncertain. This study aims to compare the effects of volatile anesthesia (VA) and total intravenous anesthesia (TIVA) on outcomes in AIS patients undergoing EVT.

We conducted a systematic search of PubMed, Embase, and Cochrane databases for studies comparing VA and TIVA in this context. Key outcomes assessed were favorable functional outcome (defined as a Modified Rankin Scale [mRS] 0-2), mortality, successful recanalization (mTICI 2b/3), and intraoperative mean arterial pressure (MAP). A subgroup analysis was also performed for patients with anterior circulation stroke.

A total of 568 patients from four observational studies were included, of whom 187 (33%) received TIVA. In the unadjusted analysis, no statistically significant differences were observed between TIVA and VA in terms of favorable functional outcome (OR 1.28; p = 0.403), mortality (OR 0.54; p = 0.082), successful recanalization (OR 1.38; p = 0.344), or MAP (MD -0.56; p = 0.755). Adjusted ORs (aORs) were extracted from multivariable models, with covariates varying across studies. The aORs suggested TIVA may be associated with improved outcomes, being linked to a higher likelihood of favorable functional outcome (aOR 1.96, 95% CI [1.15-3.34], p = 0.013) and reduced mortality (aOR 0.40, 95% CI [0.20-0.79], p = 0.008). In the subgroup of patients with anterior circulation stroke, TIVA was similarly associated with better recovery (aOR 2.66; p = 0.033) and lower mortality (aOR 0.38; p = 0.002) at 3 months, but no significant differences were found when the timing after stroke was not specified.

Among AIS patients undergoing EVT, TIVA may lead to improved functional outcome and reduced mortality compared to VA. These findings support the use of TIVA as a potentially more favorable strategy in this context, warranting further prospective trials.