GA During Thrombectomy May Boost Stroke Outcomes

TOPLINEGeneral anesthesia (GA) during endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) was associated with improved odds of functional independence at 90 days and successful reperfusion compared with non-GA approaches but was linked to an increased risk for intraoperative hypotension, a meta-analysis showed.METHODOLOGYResearchers conducted a systematic review and Bayesian meta-analysis including 10 randomized controlled trials identified using PubMed/MEDLINE, Embase, and Cochrane Central Register of Controlled Trials.The trials were published from 2016 to 2025 and conducted across Europe, Asia, and North America. They included 1601 adults with AIS (mean age, 70 years; 46.6% women) and compared GA with non-GA strategies during EVT.Primary outcomes were a change in functional independence (modified Rankin Scale [mRS] score, 0-2) at 90 days, successful reperfusion (thrombolysis in cerebral ischemia grade 2b-3), and 90-day mortality.Secondary outcomes were an excellent functional outcome (mRS score, 0-1), early neurologic improvement (change in the NIH Stroke Scale score at 24 hours), adverse events (symptomatic intracranial hemorrhage [sICH], pneumonia, and intraoperative hypotension), and the length of hospital and ICU stay.TAKEAWAYGA was associated with higher odds of functional independence at 90 days (odds ratio [OR], 1.24; posterior probability of superiority, 94.2%), exceeding the prespecified threshold of 80% for substantial evidence of benefit.Successful reperfusion rates were higher with GA (OR, 1.73; posterior probability of superiority > 99%).No substantial between-group differences were observed in odds for 90-day mortality, an excellent functional outcome, sICH, or the length of hospital or ICU stay.GA was associated with increased risk for intraoperative hypotension (OR, 4.28; posterior probability of superiority, 0.01%) and of pneumonia (OR, 1.60; posterior probability of superiority, 3%).IN PRACTICE“GA may be advantageous when it is rapid, protocolized, and maintains stable cerebral perfusion. Future studies should move beyond the simple GA vs non-GA contrast and determine which patients benefit from specific anesthetic approaches. The estimated benefit is modest, even if clinically meaningful, but not so large that it overwhelms questions of implementation, center workflow, anesthesia availability, and patient selection,” wrote the authors of an accompanying editorial, led by Gustavo A. Patino, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan.SOURCEThe study, led by Philip Heesen, Heidelberg University Hospital, Heidelberg, Germany, was published online on July 16 in Neurology.LIMITATIONSBlinding of the intervention was not possible in any of the trials, introducing potential performance and detection bias. The non-GA comparator was heterogeneous, which may have contributed to between-study variability. Conversion rates from non-GA to GA varied substantially. The meta-analysis used aggregate study-level data, limiting the ability to explore patient-level effect modifiers. Data on procedural time metrics were inconsistently reported across trials. Given the randomized controlled trial setting, the generalizability of these findings to centers with less timely anesthesia availability was uncertain.DISCLOSURESThe study received no targeted funding. The investigators reported no relevant conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.