% 0期刊文章%道格拉斯·坎贝尔%伊莉斯巴特勒%一个Ruby布莱斯·坎贝尔% Jess Ho % p . Alan理发师% T全身麻醉相比,在血管内血栓切除术Non-GA缺血性中风% B系统回顾和荟萃分析的随机对照试验% D R 10.1212 / WNL 2023%。0000000000207066 % J首页神经病学% P e1655-e1663 % V 100% N 16% X背景和目标血管内血栓切除术(EVT)大血管闭塞缺血性中风是在全身麻醉下进行(GA)或与non-GA技术如有意识的镇静或局部麻醉。先前的小荟萃分析显示优越的血管再通率和提高功能恢复与GA相比non-GA技术。进一步的随机对照试验(相关的)的出版可以提供指导在选择GA和non-GA技术更新。系统搜索方法试验中风EVT的病人被随机分为GA或执行non-GA Medline, Embase,科克伦中心注册的对照试验。用一种随机影响模型系统回顾和荟萃分析。七个相关结果包含在系统回顾和荟萃分析。这些试验包括共有980名参与者(GA, N = 487;non-GA, N = 493)。遗传算法提高了血管再通9.0% (GA 84.6% vs non-GA 75.6%;优势比[或]1.75,95%可信区间1.26 - -2.42,p = 0.0009),功能恢复患者的比例提高了8.4% (GA 44.6% vs non-GA 36.2%;或1.43,95%可信区间1.04 - -1.98,p = 0.03)。 There was no difference in hemorrhagic complications or 3-month mortality.Discussion In patients with ischemic stroke treated with EVT, GA is associated with higher recanalization rates and improved functional recovery at 3 months compared with non-GA techniques. Conversion to GA and subsequent intention-to-treat analysis will underestimate the true therapeutic benefit. GA is established as effective in improving recanalization rates in EVT (7 Class 1 studies) with a high Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) certainty rating. GA is established as effective in improving functional recovery at 3 months in EVT (5 Class 1 studies) with a moderate GRADE certainty rating. Stroke services need to develop pathways to incorporate GA as the first choice for most EVT procedures in acute ischemic stroke with a level A recommendation for recanalization and level B recommendation for functional recovery.BP=blood pressure; CS=conscious sedation; EVT=endovascular thrombectomy; GA=general anesthesia; GRADE=Grading of Recommendations, Assessment, Development, and Evaluations; LA=local anesthesia; mRS=modified Rankin score; NTT=number needed to treat; OR=odds ratio; RCT=randomized controlled trial; TICI=Thrombolysis in Cerebral Infarct %U //www.ez-admanager.com/content/neurology/100/16/e1655.full.pdf