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

INTRODUCTION: 10 randomized controlled trials (RCTs) have compared general anesthesia (GA) with non-GA 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