General anesthesia vs. conscious sedation and local anesthesia for endovascular treatment in patients with posterior circulation acute ischemic stroke: An updated systematic review and meta-analysis

• Published in: Journal of stroke and cerebrovascular diseases Vol. 33; no. 1; p. 107471
• Main Authors: Fan, Bin, Qiu, Li-Quan, Zhang, Li-Cai, Li, Qiang, Lu, Bin, Chen, Guan-Yu
• Format: Journal Article
• Language: English
• Published: United States 01.01.2024
• Subjects: Anesthesia, General - adverse effects; Anesthesia, Local - adverse effects; Brain Ischemia - complications; Brain Ischemia - diagnosis; Brain Ischemia - therapy; Conscious Sedation - adverse effects; Conscious Sedation - methods; Endovascular Procedures - adverse effects; Endovascular Procedures - methods; Humans; Intracranial Hemorrhages - etiology; Ischemic Stroke - etiology; Stroke - diagnosis; Stroke - etiology; Stroke - therapy; Thrombectomy - adverse effects; Treatment Outcome; meta-analysis; Endovascular Therapy; General Anesthesia; Acute Ischemic Stroke; Posterior circulation stroke
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2023.107471

The best anesthetic choice for patients with acute posterior circulation stroke during endovascular treatment (EVT) remains uncertain. We searched five databases to identify studies that met the inclusion criteria. Our primary outcome measure was functional independence (FI). Secondary outcomes were 3-month mortality, any intracranial hemorrhage (ICH), symptomatic ICH (sICH), successful reperfusion, and procedure- and ventilator-associated complications. A total of 10 studies were included in our meta-analysis. No significant differences were detected between the general anesthesia (GA) and conscious sedation and local anesthesia (CS/LA) groups in 3-month FI (nine studies; OR=0.69; 95% CI 0.45-1.06; P=0.083; I =66%;), 3-month mortality (nine studies; OR=1.41; 95% CI 0.94-2.11; P=0.096; I =61.2%;), any ICH (three studies; OR=0.75; 95% CI 0.44-1.25; P=0.269; I =0%;), or sICH (six studies; OR=0.64; 95% CI 0.40-1.04; P=0.073; I =0%;). No significant differences were observed for successful reperfusion (10 studies; OR=1.17; 95% CI 0.91-1.49; P=0.219; I2=0%;), procedure-related complications (four studies; OR=1.14; 95% CI 0.70-1.87; P=0.603; I =7.9%;), or respiratory complications (four studies; OR=1.19; 95% CI 0.61-2.32; P=0.616; I =64.9%;) between the two groups. Our study showed no differences in 3-month FI, 3-month mortality, and successful reperfusion between patients treated with GA and those treated with CS/LA. Additionally, no increased risk of hemorrhagic transformation or pulmonary infection was observed in the CS/LA group. These results indicate that CS/LA may be an EVT option for acute posterior circulation stroke patients.