We aimed to compare anesthetic modalities in MeVO stroke treated with EVT.

The optimal anesthesia approach during endovascular treatment (EVT) for acute ischemic stroke, especially with medium or distal vessel occlusion (MeVO), lacks clear guidance due to limited data. Given the difficulties in accessing small vessels in agitated patients, physicians may opt for general anesthesia (GA). Nevertheless, the outcomes following GA versus non-GA in patients with MeVO remain insufficiently explored.

For this systematic review and meta-analysis, we followed established guidelines and protocols. We conducted searches in electronic databases for English-language literature released up to October 2024. A comparison was performed concerning efficacy, procedural aspects, and safety outcomes. Odds ratios (ORs) along with their 95% confidence intervals (CIs) were computed using the random-effects model.

After literature search, six studies with 3019 patients fit the selection criteria. Of included patients, 883 (29.2%) were treated under GA. The median age of participants ranged from 68 to 76 years, with median initial National Institute for Health Stroke Scale scores varying from 4 to 15.5. While recanalization metrics were comparable, there was a trend toward higher good functional outcomes (modified Rankin scale 0-2 at 90-day) among patients treated with GA (OR, 1.30 [95% CI, 0.99–1.72]). Procedural complications were similar between groups. Patients treated with GA had higher 90-day mortality (OR 1.98, 95% CI 1.43–2.72).

While GA may in theory benefit MeVO cases, our results showed inconsistent benefits alongside higher mortality rates in the GA group. More robust, randomized trials are necessary. In the interim, personalized anesthesia decisions are recommended.