The impact of anesthesia choice during thrombectomy for distal and medium vessel occlusions: A systematic review and meta-analysis

Background Physicians may opt for general anesthesia (GA) during endovascular thrombectomy (EVT) when treating distal and medium vessel occlusion (DMVO), particularly in agitated patients where accessing small vessels presents challenges. However, little is known about how GA and non-GA approaches compare in terms of safety, efficacy, and procedural outcomes for DMVO patients undergoing EVT. Methods This systematic review and meta-analysis conform to the established guidelines and protocols for this type of data synthesis. We searched Medline, Embase, Web of Science, and the Cochrane Library up to August 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Results Six studies with 3019 patients fit the selection criteria. Of the 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. There was no statistically significant difference in terms of good functional outcomes (modified Rankin scale 0–2 at 90 days) between the two groups (OR, 0.97 [95% CI, 0.72–1.30]; p = 0.83). Recanalization metrics and procedural complications were similar between groups. Patients treated under GA had higher 90-day mortality (OR, 1.98, [95% CI 1.43–2.72]; p < 0.01). Conclusion In this study, both anesthesia methods demonstrated comparable effectiveness; however, GA was associated with higher 90-day mortality. Additional robust evidence is needed to validate these findings and establish their clinical significance across different subgroups of DMVO.