Effects of general anesthesia on short-term outcomes of patients with acute ischemic stroke after endovascular treatments: a meta-analysis

The optimal anesthetic strategy for endovascular treatment (EVT) in acute ischemic stroke (AIS) remains uncertain. This meta-analysis of randomized controlled trials (RCTs) compared the effects of general anesthesia (GA) and non-general anesthesia (non-GA) on reperfusion success and clinical outcomes after EVT. A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was performed. Eligible RCTs compared GA versus non-GA in adults with AIS undergoing EVT. The primary outcome was successful angiographic reperfusion (modified Thrombolysis in Cerebral Infarction 2b–3). Secondary outcomes included functional independence (modified Rankin Scale 0–2) and all-cause mortality at 3 months. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model accounting for the influence of potential heterogeneity. Eleven RCTs encompassing 1,674 patients were included. Compared with non-GA, GA significantly increased the likelihood of successful reperfusion (RR = 1.08, 95% CI 1.02–1.13; I 2 = 35%). However, GA did not significantly affect functional independence (RR = 1.11, 95% CI 0.98–1.26; I 2 = 15%) or all-cause mortality (RR = 1.00, 95% CI 0.81–1.24; I 2 = 0%). Subgroup analyses showed consistent results across vascular territories and baseline NIHSS strata. The certainty of evidence was moderate for reperfusion and low for functional and mortality outcomes. In conclusion, although GA improved angiographic reperfusion, this did not translate into improved 90-day functional outcomes. These findings support individualized anesthetic selection based on procedural and patient factors rather than routine GA use. Systematic review registration https://www.crd.york.ac.uk/prospero/search , identifier CRD420251169607.