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Updated meta-analysis of 10 RCTs shows general anesthesia during thrombectomy significantly improves revascularization rates compared to conscious sedation. When limited to trials using established stroke selection criteria, general anesthesia also improved functional independence at 90 days without increased mortality or hemorrhagic complications.
Mosallami Aghili et al, J NeuroInterv Surg 2026: Anesthesia and thrombectomy: updated meta-analysis of randomized controlled trials. Read the full paper.
Problem: Anesthesiology definitely needs to be involved early in stroke codes where thrombectomy is an option, but whether general anesthesia versus conscious sedation provides superior outcomes during endovascular thrombectomy for large vessel occlusion stroke has been an open question.
Result: General anesthesia significantly improved both revascularization success (OR 1.79) and functional independence in appropriately selected patients (OR 1.58) without safety concerns.
Open Questions: The optimal anesthetic protocol and which specific patient subgroups benefit most from general anesthesia during thrombectomy remain to be defined.
Written on February 24th, 2026 by Habakuk Hain