Arturi Federica, Melegari Gabriele, Gazzotti Fabio, Bertellini Elisabetta, Barbieri Alberto
School of Anaesthesia and Intensive Care, University of Modena and Reggio Emilia, Via del Pozzo 71, 4112 Modena, Italy.
Department of Anaesthesia and Intensive Care, Azienda Ospedaliera Universitaria di Modena, Via del Pozzo 71, 4112 Modena, Italy.
Neurol Int. 2025 Jul 25;17(8):115. doi: 10.3390/neurolint17080115.
BACKGROUND/OBJECTIVES: Endovascular thrombectomy has become a mainstay in the treatment of acute ischemic stroke caused by large vessel occlusion. Among the multiple factors that influence outcomes, the choice of anesthetic technique-general anesthesia (GA), conscious sedation (CS), or local anesthesia (LA)-remains controversial. This narrative review aims to critically examine and synthesize current evidence comparing the efficacy and safety of different anesthetic strategies in endovascular stroke treatment.
A structured search of the PubMed database was conducted using the terms "stroke treatment", "endovascular stroke treatment", "anesthesia", "general anesthesia", "conscious sedation", and "local anesthesia". The search focused on clinical trials involving human subjects published in English. Studies were included if they compared at least two anesthetic techniques during thrombectomy and reported outcomes such as neurological recovery, mortality, or complication rates. Reviews, case reports, and animal studies were excluded.
Several randomized controlled trials and observational studies show comparable functional outcomes between GA and CS, though CS may confer advantages in early neurological recovery and reduced complications. Local anesthesia, though less studied, may offer favorable outcomes in selected patients. General anesthesia appears to be associated with greater hemodynamic variability and a higher risk of post-procedural infections, particularly in unsuccessful interventions. Maintaining stable blood pressure and minimizing ventilation duration are crucial to improving patient prognosis.
While both GA and CS are viable options during thrombectomy, CS and LA may provide a safer profile in selected patients by preserving hemodynamic stability and reducing infectious risk. Personalized anesthetic strategies and further high-quality trials are warranted.
背景/目的：血管内血栓切除术已成为治疗由大血管闭塞引起的急性缺血性卒中的主要手段。在影响治疗结果的多种因素中，麻醉技术的选择——全身麻醉（GA）、清醒镇静（CS）或局部麻醉（LA）——仍存在争议。本叙述性综述旨在严格审查和综合当前比较不同麻醉策略在血管内卒中治疗中疗效和安全性的证据。
使用“卒中治疗”“血管内卒中治疗”“麻醉”“全身麻醉”“清醒镇静”和“局部麻醉”等术语对PubMed数据库进行结构化检索。检索重点是发表于英文的涉及人类受试者的临床试验。纳入的研究需在血栓切除术期间比较至少两种麻醉技术，并报告神经功能恢复、死亡率或并发症发生率等结果。排除综述、病例报告和动物研究。
多项随机对照试验和观察性研究表明，全身麻醉和清醒镇静的功能结局相当，但清醒镇静可能在早期神经功能恢复和减少并发症方面具有优势。局部麻醉虽研究较少，但在特定患者中可能有良好结局。全身麻醉似乎与更大的血流动力学变异性和术后感染风险较高相关，尤其是在干预未成功的情况下。维持稳定血压和尽量缩短通气时间对改善患者预后至关重要。
虽然全身麻醉和清醒镇静在血栓切除术期间都是可行的选择，但清醒镇静和局部麻醉通过保持血流动力学稳定和降低感染风险，可能在特定患者中提供更安全的方案。需要个性化的麻醉策略和进一步的高质量试验。
