General Anesthesia Versus Conscious Sedation for Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

The optimal anesthetic technique during endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) remains uncertain. General anesthesia (GA) provides airway protection and procedural stability, whereas conscious sedation (CS) offers faster workflow and the ability to monitor neurological status. This updated systematic review and meta-analysis (SRMA) aims to summarize and update the existing literature from randomized controlled trials (RCTs) to guide the selection of the most appropriate anesthetic technique during EVT for AIS. We searched the electronic databases of PubMed, ProQuest, and Scopus from their inception to October 17, 2025. No time or language restrictions were applied. Only RCTs were included. The SRMA protocol was registered with PROSPERO (ID: CRD420251170612) on 18th October 2025. Statistical analysis was performed using Review Manager software. Risk of bias (RoB) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were assessed. Of the 348 records screened, ten eligible RCTs were included. GA was associated with a significantly higher rate of successful reperfusion, but there was no difference in 90-day functional independence on modified Rankin scale (mRS) score, or mortality compared with CS. GA increased the risk of hypotension and prolonged the door-to-puncture time, but not other complications or process times. The RoB was low for most included studies. The certainty of evidence for study outcomes was moderate on GRADE. To conclude, GA has superior recanalization rates than CS, but functional outcomes and mortality are similar. Conversely, hypotension occurs more frequently with GA, while CS provides a faster workflow.