General Versus Non-General Anesthesia in Endovascular Thrombectomy for Distal/Medium Vessel Occlusions: A Systematic Review and Meta-Analysis.

Abstract

Purpose: With the expanding use of endovascular thrombectomy (EVT) for distal and medium vessel occlusions (DMVOs), evaluating how anesthesia type affects clinical outcomes is essential. This meta-analysis compared outcomes between general anesthesia (GA) and non-GA in patients undergoing EVT for DMVOs.

Methods: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science for eligible studies. Primary outcomes included successful reperfusion, 90-day mortality, excellent functional outcome (Modified Rankin Scale [mRS] 0-1), and symptomatic intracranial hemorrhage (sICH). Risk ratios (RR) with 95% confidence intervals (CI) were calculated using the Mantel-Haenszel method and a random-effects model. Heterogeneity was assessed with I² and Cochran's Q test.

Results: Five studies comprising 1643 patients were included. There was no significant difference in successful reperfusion between GA and non-GA groups (RR 1.01; 95% CI 0.94-1.08; I² = 32.3%). However, GA was associated with significantly higher 90-day mortality (RR 1.55; 95% CI 1.23-1.96; I² = 0%). Excellent functional outcomes (mRS 0-1 at 90 days) were similar between groups (RR 0.92; 95% CI 0.78-1.10; I² = 24.2%). No statistically significant difference in sICH was observed between the GA and non-GA groups (RR 2.61; 95% CI 0.99-6.86; I² = 40.8%). However, the leave-one-out analysis revealed a significant association indicating a higher risk of sICH with GA (RR 3.88; 95% CI 1.79-8.41; I² = 0%).

Conclusion: GA was linked to increased 90-day mortality in EVT for DMVOs, with no differences in reperfusion or functional recovery. A possible higher risk of sICH was noted. Further prospective studies are needed to guide anesthetic strategy.