AUTHOR=Wan Teng-Fei , Zhang Jian-Rong , Liu Liang 

TITLE=Effect of General Anesthesia vs. Conscious Sedation on the Outcomes of Acute Ischemic Stroke Patients After Endovascular Therapy: A Meta-Analysis of Randomized Clinical Trials

JOURNAL=Frontiers in Neurology

VOLUME=10

YEAR=2019

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2019.01131

DOI=10.3389/fneur.2019.01131

ISSN=1664-2295

ABSTRACT=<p><bold>Background:</bold> Endovascular therapy is the standard treatment for acute ischemic stroke (AIS) patients caused by a large vessel occlusion in the anterior circulation, whereas the impacts of general anesthesia (GA) vs. conscious sedation (CS) for such procedures remained as a continued debate.</p><p><bold>Methods:</bold> We systematically searched PubMed, Embase, and <ext-link ext-link-type="uri" xlink:href="https://www.ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>. We restricted our search to RCTs that examined the clinical outcomes of endovascular therapy with GA vs. CS. The Cochrane Risk of Bias Tool was used to assess study quality. Random-effects or fixed-effects meta-analyses were used for evaluating all outcomes.</p><p><bold>Results:</bold> A total of three randomized clinical trials met our inclusion criteria, with 368 individuals enrolled. Patients were randomized to receive GA or CS during endovascular therapy. In a meta-analysis of these trials, patients in the GA group were associated with favorable functional outcome (mRS score ≤ 2) compared with the CS group (pooled OR = 1.81, 95% CI: 1.17–2.79, <italic>P</italic> = 0.008). Besides, patients in the GA group had higher odds of successful reperfusion (pooled OR = 1.80, 95% CI: 1.05–3.08, <italic>P</italic> = 0.033), but no significant differences were seen in symptomatic intracranial hemorrhage (pooled OR = 0.54, 95% CI: 0.11–2.57, <italic>P</italic> = 0.308), vessel dissection or perforation (pooled OR = 1.38, 95% CI: 0.30–6.31, <italic>P</italic> = 0.679), migration of embolus to a new territory (pooled OR = 2.28, 95% CI: 0.89–5.87, <italic>P</italic> = 0.085), post-operative pneumonia (pooled OR = 1.74, 95% CI: 0.76–4.01, <italic>P</italic> = 0.149), and all-cause mortality at 90 days (pooled OR = 0.73, 95% CI: 0.43–1.26, <italic>P</italic> = 0.263) compared with the CS group.</p><p><bold>Conclusion:</bold> Performing endovascular therapy with GA, compared with CS, improves functional independence after 90 days significantly for patients with AIS caused by a large vessel occlusion in the anterior circulation. However, additional larger and multi-center randomized controlled trials to definitively confirm our findings are warranted for the limitation of the small sample size in this study.</p>