General anesthesia versus conscious sedation during endovascular treatment in posterior circulation large vessel occlusion: A systematic review and meta-analysis

Eur Stroke J. 2023 Mar;8(1):85-92. doi: 10.1177/23969873221127738. Epub 2022 Oct 13.

Abstract

Purpose: The optimal anesthetic approach in the endovascular treatment (EVT) of patients with posterior circulation large vessel occlusion (PC-LVO) strokes is not clear. Little data has been published and no randomized clinical trials have been conducted so far. We aimed to perform an updated meta-analysis to compare clinical and procedural outcomes between conscious sedation (CS) and general anesthesia (GA).

Methods: We reviewed the literature of the studies reporting CS and GA in patients with endovascularly-treated PC-LVO. The primary outcome was the functional outcome at 3 months measured using the modified Rankin Scale (mRS). A good functional outcome was defined as having a mRS 0-2. Secondary outcomes were mortality at 3 months, final successful recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) scale from 2b to 3) and complete recanalization (mTICI of 3) and times from stroke onset to EVT completion. Random-effects models were completed to pool the outcomes and the I 2 value was calculated to assess heterogeneity.

Findings: Eight studies with a total of 1351 patients were included. The pooled results reveal that CS use was associated with higher rates of good outcome (OR 2.41, 95% CI 1.58-3.64, I 2 = 49.67%) and with lower mortality at 3 months (OR 0.48, 95% CI 0.28-0.82, I 2 =57.11%). No significant differences were observed in the final reperfusion rates, procedural duration, and time from stroke onset to EVT completion.

Conclusion: In this meta-analysis, GA was associated with significantly lower rates of functional independence at 3 months in patients with PC-LVO strokes.

Keywords: Meta-analysis; conscious sedation; endovascular treatment; general anesthesia; posterior circulation-large vessel occlusion.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Anesthesia, General
  • Cerebral Infarction
  • Conscious Sedation / methods
  • Endovascular Procedures* / methods
  • Humans
  • Stroke* / therapy
  • Treatment Outcome