Abstract Details

Title General Versus Non-general Anesthesia in Endovascular Treatment for Posterior Circulation Stroke: A Systematic Review and Meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-004

Objective

Compare outcomes under general anesthesia (GA) versus non-general anesthesia (non-GA) in posterior-circulation stroke undergoing Endovascular treatment (EVT).

Background EVT is widely used to treat large vessel occlusion strokes, and outcomes are closely related to both patient and procedural characteristics. Consequently, the type of anesthesia may influence procedural success by reducing patient movement and protecting the airway. However, the potential impact of the anesthesia technique on posterior-circulation stroke undergoing EVT remains unclear.

Design/Methods We searched Pubmed, Embase, Scopus, Cochrane, and Web of Science for studies that evaluated the impact of anesthesia type on posterior circulation stroke patients undergoing EVT. Statistical analyses in R Studio used a random-effects model to estimate ORs (95% CIs), assessing heterogeneity. Primary efficacy endpoint was successful recanalization (mTICI 2b-3); secondary efficacy endpoint was functional independence (mRS 0–2 at 90 days); and the safety endpoint was mortality.

Results Data of 3,899 patients who underwent EVT for posterior circulation stroke were collected, of whom 1,950 received GA and 1,949 were treated with non-GA, including local anesthesia (LA), conscious sedation (CS), or monitored anesthesia care (MAC). Pooled analysis of matched studies (n = 9) showed significantly higher odds of successful recanalization with GA (OR: 1.36; 95% CI: 1.04–1.78; p = 0.0227). The likelihood of achieving functional independence in matched studies (n = 11) was not significantly different (OR: 1.00; 95% CI: 0.86–1.16; p = 0.9510). For 90-day mortality in matched studies (n = 11), there was no significant difference (OR: 0.95; 95% CI: 0.86–1.05; p = 0.3438).

Conclusions GA was associated with higher odds of successful recanalization in posterior-circulation EVT, without differences in 90-day functional independence or mortality. Randomized trials with protocolized physiologic targets are needed to determine whether this procedural advantage of GA translates into improved 90-day functional outcomes.

Authors/Disclosures
Mariana Letícia d. Maximiano, MD PRESENTER	Dr. Maximiano has nothing to disclose.
Lucca T. Carretta, Medical student	Mr. Carretta has nothing to disclose.
Rudolfh B. Arend, Sr.	Dr. Arend has nothing to disclose.
Henrique P. Gnoatto	Mr. Gnoatto has nothing to disclose.
Victor L. Kauer, Student	Mr. Kauer has nothing to disclose.
Bruna Zardin, MD	Miss Zardin has nothing to disclose.
Filipe V. Ribeiro, MD	Ms. Ribeiro has nothing to disclose.
Anderson S. Corin	Mr. Corin has nothing to disclose.
Nicole B. Oliveira	Ms. Oliveira has nothing to disclose.
Tassiane C. Morais, PhD	Prof. Morais has nothing to disclose.
FERNANDO R. OLIVEIRA, Sr., PhD	Dr. OLIVEIRA has nothing to disclose.
LEANDRO D. BARBOSA, MD, PhD	Prof. BARBOSA has nothing to disclose.
Alex Roman, MD	Dr. Roman has nothing to disclose.
AHMET GÜNKAN, MD	Dr. GÜNKAN has nothing to disclose.

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