General Versus Non-general Anesthesia in Endovascular Treatment for Posterior Circulation Stroke: A Systematic Review and Meta-analysis
Lucca Tamara Alves Carretta1, Mariana Letícia Bastos Maximiano4, Rudolfh Batista Arend5, Henrique Padilha Gnoatto5, Victor Luiz Ferreira Kauer5, Bruna Lara Zardin6, Filipe Virgilio Ribeiro7, Anderson Silva Corin8, Nicole Baptista de Oliveira3, Tassiane Cristina Morais2, Fernando Rocha Oliveira2, Leandro de Assis Barbosa9, Alex Roman5, AHMET GÜNKAN10
1Medicine, 2Postgraduate department, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), 3Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), 4Federal Fluminense University, 5Federal University of Fronteira Sul, 6Federal University of Fronteira Sull, 7Barão de Mauá University Center, 8Federal University of Pelotas, 9Department of Neurosurgery, Hospital Estadual Central, 10Department of Vascular and Interventional Radiology, University of Arizona
Objective:
Compare outcomes under general anesthesia (GA) versus non-general anesthesia (non-GA) in posterior-circulation stroke undergoing Endovascular treatment (EVT).
Background:
EVT is widely used to treat large vessel occlusion strokes, and outcomes are closely related to both patient and procedural characteristics. Consequently, the type of anesthesia may influence procedural success by reducing patient movement and protecting the airway. However, the potential impact of the anesthesia technique on posterior-circulation stroke undergoing EVT remains unclear.
Design/Methods:
We searched Pubmed, Embase, Scopus, Cochrane, and Web of Science for studies that evaluated the impact of anesthesia type on posterior circulation stroke patients undergoing EVT. Statistical analyses in R Studio used a random-effects model to estimate ORs (95% CIs), assessing heterogeneity. Primary efficacy endpoint was successful recanalization (mTICI 2b-3); secondary efficacy endpoint was functional independence (mRS 0–2 at 90 days); and the safety endpoint was mortality.
Results:
Data of 3,899 patients who underwent EVT for posterior circulation stroke were collected, of whom 1,950 received GA and 1,949 were treated with non-GA, including local anesthesia (LA), conscious sedation (CS), or monitored anesthesia care (MAC). Pooled analysis of matched studies (n = 9) showed significantly higher odds of successful recanalization with GA (OR: 1.36; 95% CI: 1.04–1.78; p = 0.0227). The likelihood of achieving functional independence in matched studies (n = 11) was not significantly different (OR: 1.00; 95% CI: 0.86–1.16; p = 0.9510). For 90-day mortality in matched studies (n = 11), there was no significant difference (OR: 0.95; 95% CI: 0.86–1.05; p = 0.3438).
Conclusions:
GA was associated with higher odds of successful recanalization in posterior‑circulation EVT, without differences in 90‑day functional independence or mortality. Randomized trials with protocolized physiologic targets are needed to determine whether this procedural advantage of GA translates into improved 90-day functional outcomes.
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