Outcomes of general anesthesia versus conscious sedation for Stroke undergoing endovascular treatment: a meta-analysis

Abstract

Background The impact of anesthesia strategy on the outcomes of acute ischemic stroke (AIS) patients undergoing endovascular treatment is currently controversy. Thus, we performed this meta-analysis to compare the differences of clinical and angiographic outcomes between general anesthesia (GA) and conscious sedation (CS). Methods A literature search in PubMed, Embase, and Web of Knowledge databases through February 2019 was conducted for related records on GA and CS of AIS undergoing endovascular treatment. The results of the studies were pooled and meta-analyzed with fixed- or random-effect model based on heterogeneity test in total and subgroup analyses. Results Twenty-three studies including 6703 patients were analyzed in this meta-analysis. We found that patients in the GA group have lower odds of favorable functional outcome (mRS scores ≤2) compared with the CS group (odds ratio [OR] = 0.62, 95% confidence interval [CI]: 0.49–0.77), and higher risk of mortality (OR = 1.68, 95% CI: 1.49–1.90), pneumonia (OR = 1.78, 95% CI: 1.40–2.26), symptomatic intracranial hemorrhage (OR = 1.64, 95% CI: 1.13–2.37). However, no significant differences were seen between the groups in the rate of recanalization (OR = 1.07, 95% CI: 0.89–1.28), vessel dissection or perforation (OR = 1.00, 95% CI: 0.98–1.03) and asymptomatic intracranial hemorrhage (OR = 1.19, 95% CI: 0.96–1.47). While in the RCT subgroup analysis, we found patients in the GA group does not show lower rate of favorable functional outcome compared with the CS group (OR = 1.84, 95% CI: 1.17–2.89). And there was no significant difference in the rate of mortality between GA and CS groups during RCT subgroup analysis (OR = 0.74, 95% CI: 0.43–1.27). Conclusions AIS patients performed endovascular treatment under GA compared with CS was associated with worse functional outcome and increased rate of mortality, but differences in worsened outcomes do not exist when one looks into the GA vs. CS RCTs. Moreover, these findings are mainly based on the retrospective studies and additional multi-center randomized controlled trials to definitively address these issues is warranted. Electronic supplementary material The online version of this article (10.1186/s12871-019-0741-7) contains supplementary material, which is available to authorized users.

Factors Associated with Failure of Reperfusion in Endovascular Therapy for Acute Ischemic Stroke

“…In this study, general anesthesia was associated with a higher reperfusion rate when compared to conscious sedation. This finding has been previously described in a RCT [ 27 ]; however, a large systematic review and meta-analysis of 6703 patients did not find a difference between anesthesia type and rates of sufficient reperfusion [ 28 ]. This interesting aspect should be further explored in future trials, since the decision for or against general anesthesia is frequently encountered in daily practice [ 29 ].…”

Management of acute ischemic stroke

“…Multiple non-randomized and a few randomized studies have examined different options, including conscious sedation or general anesthesia. In general, non-randomized studies have found that general anesthesia leads to worse functional outcome and a higher mortality rate,787980818283 but some randomized, single center trials including AnStroke,84 SIESTA,85 and GOLIATH,86 showed no difference in mortality for general anesthesia versus conscious sedation, with better functional outcomes for general anesthesia in SIESTA but no difference in AnStroke or GOLIATH.…”

Conscious sedation compared to general anesthesia for intracranial mechanical thrombectomy: A meta‐analysis

“…Former meta-analyses suggested that general anesthesia compared to conscious sedation for endovascular therapy decreases recovery and increases death and disability. (Abou-Chebl et al, 2010;Brinjikji et al, 2015;Wan et al, 2019) The link of general anes- F I G U R E 3 Forest plot of the general anesthesia versus conscious sedation during the endovascular therapy for acute ischemic stroke related to successful recanalization at 24 hr F I G U R E 4 Forest plot of the general anesthesia versus conscious sedation during the endovascular therapy for acute ischemic stroke related to mortality at 90 days F I G U R E 5 Forest plot of the general anesthesia versus conscious sedation during the endovascular therapy for acute ischemic stroke related to interventional complication Mundiyanapurath et al, 2015) may be clarified by blood pressure reductions and an extended delay of time to groin puncture in the general anesthesia group, both of which have been related to inferior endovascular therapy results. (Davis et al, 2012) Opposite to many nonrandomized studies and former meta-analyses, this study appears to support the idea that endovascular therapy may be performed with both conscious sedation and general anesthesia with favoring general anesthesia due to its relatively lower symptomatic intracranial hemorrhage result (p = .05).…”

“…Former systematic review and meta-analyses (Abou-Chebl et al, 2010;Brinjikji et al, 2015;Wan et al, 2019) and observational studies (Abou-Chebl et al, 2010Just et al, 2016;Mundiyanapurath et al, 2015) showed worse results from general anesthesia compared with conscious sedation in endovascular therapy.…”