The role of anesthesia in endovascular therapy management of ischemic stroke: A systematic review and meta-analysis

Abstract

Background: Endovascular treatment and thrombolytic therapy are widely used as the standard treatment for acute ischemic strokes. General Anesthesia (GA) is preferred over Conscious Sedation (CS) because it is associated with lower pain, anxiety, agitation and aspiration risk. However time is very fundemental in acute ischemic stroke treatment. Methods: The search was done on the 30th of December 2022. The inclusion criteria of the studies were if they were randomized controlled clinical trials in design and compared between using conscious sedation and general anesthesia in endovascular treatment along with thrombolytic therapy. Results: The total number of patients included in our analysis was 743 from six clinical trials. Our models showed a significant association between conscious sedation and improved disability (OR=1.32; 95%CI: 1.10–1.59). The model demonstrated that conscious sedation was significantly associated with lower mean stroke to procedure time (WMD=-11.93; 95%CI: -23.72- -0.14) and lower mean hospital arrival to procedure time (WMD=-8.30; 95%CI: -13.88- -2.72). Moreover, our analysis revealed that conscious sedation was significantly associated with lower hypotensive episodes (WMD=0.67; 95%CI: 0.48–0.95) and lower use of vasoactive drugs (WMD=0.75; 95%CI: 0.57–0.99). There were no significant differences between the two study groups in technical failures, successful recanalization or mortality. Conclusion: CS demonstrated improved disability, shorter times to procedure, fewer hypotensive events, and lower use of vasoactive drugs. All of which reflect a better quality for CS over GA. Given together, these findings can help guide the clinical decision which should be tailored to the patients’ needs.

Keywords

• Endovascular treatment
• Ischemic stroke
• Anesthesia
• Epidemiology