Anesthesia and thrombectomy: updated meta-analysis of randomized controlled trials

Introduction 10 randomized controlled trials (RCTs) have compared general anesthesia (GA) with nonGA sedation for endovascular thrombectomy (EVT) in patients with emergent large vessel occlusion (ELVO). We performed an updated meta-analysis of the existing trials. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, all RCTs comparing GA versus non-GA during EVT for ELVO published between May 2022 and October 2025 were identified. Two meta-analyses were performed. The primary meta-analysis included all trials, whereas the secondary analysis included only those trials with inclusion criteria similar to those used in the pivotal thrombectomy trials. Results 10 RCTs were identified, of which six were included in the secondary analysis. Across all 10 trials, GA significantly increased the odds of successful revascularization compared with non-GA (n=1584; pooled OR 1.79, 95%CI 1.35 to 2.36; P<0.001; I²=0%), but no significant difference was observed in the resulting functional independence of treated patients. In the secondary analysis of six trials, GA was associated with a significant improvement in functional independence (n=648; pooled OR 1.58, 95%CI 1.15 to 2.18; P=0.005; I²=0%), in addition to higher revascularization rates. Mortality at 90 days and hemorrhagic complications did not differ significantly between the groups in either analysis. Conclusions GA significantly improved successful revascularization rates in patients undergoing EVT. In RCTs that enrolled patients based on established EVT inclusion criteria, the rate of good functional outcome at 90 days was significantly higher in patients undergoing EVT with GA compared with non-GA.