Conscious sedation versus general anesthesia during endovascular acute ischemic stroke treatment: a systematic review and meta-analysis.
OBJECTIVE
A number of studies have suggested that anesthesia type (conscious sedation versus general anesthesia) during intra-arterial treatment for acute ischemic stroke has implications for patient outcomes. We performed a systematic review and meta-analysis of studies comparing the clinical and angiographic outcomes of the 2 anesthesia types.


METHODS
In March 2014, we conducted a computerized search of MEDLINE and EMBASE for reports on anesthesia and endovascular treatment of acute ischemic stroke. Using random-effects meta-analysis, we evaluated the following outcomes: recanalization rate, good functional outcome (mRS ≤ 2), asymptomatic and symptomatic intracranial hemorrhage, death, vascular complications, respiratory complications, procedure time, time to groin, and time from symptom onset to recanalization.


RESULTS
Nine studies enrolling 1956 patients (814 with general anesthesia and 1142 with conscious sedation) were included. Compared with patients treated by using conscious sedation during stroke intervention, patients undergoing general anesthesia had higher odds of death (OR = 2.59; 95% CI, 1.87-3.58) and respiratory complications (OR = 2.09; 95% CI, 1.36-3.23) and lower odds of good functional outcome (OR = 0.43; 95% CI, 0.35-0.53) and successful angiographic outcome (OR = 0.54; 95% CI, 0.37-0.80). No difference in procedure time (P = .28) was seen between the groups. Preintervention NIHSS scores were available from 6 studies; in those, patients receiving general anesthesia had a higher average NIHSS score.


CONCLUSIONS
Patients with acute ischemic stroke undergoing intra-arterial therapy may have worse outcomes with general anesthesia compared with conscious sedation. However, the difference in stroke severity at the onset may confound the comparison in the available studies; thus, a randomized trial is necessary to confirm this association.
From the Departments of Radiology (W.B., H.J.C., G.L., D.F.K.) brinjikji.waleed@mayo.edu.
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W
Brinjikji
Center for the Science of Healthcare Delivery and the Division of Preventive Medicine (M.H.M.), Mayo Clinic, Rochester, Minnesota.
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MH
Murad
Neurology (A.A.R.).
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AA
Rabinstein
From the Departments of Radiology (W.B., H.J.C., G.L., D.F.K.) Neurosurgery (H.J.C., G.L., D.F.K.).
H J
HJ
Cloft
From the Departments of Radiology (W.B., H.J.C., G.L., D.F.K.) Neurosurgery (H.J.C., G.L., D.F.K.).
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G
Lanzino
From the Departments of Radiology (W.B., H.J.C., G.L., D.F.K.) Neurosurgery (H.J.C., G.L., D.F.K.).
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DF
Kallmes
D000768:Anesthesia, General; D002545:Brain Ischemia / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D002533:Cerebral Angiography; D016292:Procedural Sedation; D057510:Endovascular Procedures / Q000379:methods; D006801:Humans; D020127:Recovery of Function; D020521:Stroke / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D017131:Thrombectomy; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome