General Versus Non-General Anesthesia in Endovascular Treatment for Posterior Circulation Stroke: a Systematic Review and Meta-analysis.
Lucca Tamara Alves Carretta, Rudolfh Batista Arend, Henrique Padilha Gnoatto et al.
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In 30 seconds
This systematic review and meta-analysis compared general anesthesia (GA) with non-general anesthesia during endovascular therapy for posterior circulation stroke. Fourteen comparative studies included 3,899 patients. GA was associated with higher odds of successful recanalization (mTICI 2b-3; OR 1.24; 95% CI: 1.01-1.52; p = 0.0389). The analysis found no significant differences in 90-day mortality, intracranial hemorrhage, symptomatic intracranial hemorrhage, or functional independence. Thus, the technical outcome favored GA, without a demonstrable difference in the reported clinical outcomes.
Key findings
- Successful recanalization (mTICI 2b-3) was more likely with GA (OR 1.24; 95% CI: 1.01-1.52; p = 0.0389).
- No significant difference in 90-day mortality was found between GA and non-GA (OR 1.23; 95% CI: 0.92-1.63).
- GA and non-GA did not differ significantly in any intracranial hemorrhage (OR 0.72; 95% CI: 0.45-1.14) or symptomatic intracranial hemorrhage (OR 0.79; 95% CI: 0.58-1.06).
- Functional independence did not differ significantly between anesthesia groups.
Why it matters
Anesthesia choice during posterior circulation EVT may affect procedural success, but this pooled evidence did not show corresponding differences in mortality, hemorrhage, or functional independence. The distinction between a technical endpoint and patient-centred outcomes is important when interpreting the apparent recanalization advantage and weighing procedural conditions against physiological risks.
What to keep in mind
The review included comparative studies, and the abstract does not report randomized evidence; the findings therefore do not establish that anesthesia type caused the observed differences.