General Anesthesia Versus Non-GA in Endovascular Therapy for Acute Ischemic Stroke: A Systematic Review and Bayesian Meta-Analysis of RCTs.

We aimed to update the existing systematic reviewand to re-examine the cumulative randomized evidence using Bayesian statistical methods.

我们的目标是更新现有的系统评价，并使用贝叶斯统计方法重新审视累积的随机证据。

Methods

We conducted a systematic reviewfollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.

我们遵循2020年系统评价和荟萃分析报告首选条目指南进行了系统评价。

PubMed/MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to January 3, 2026, for randomized controlled trials (RCTs) comparing GA with non-GA strategies during EVT in adults with AIS.

从创刊至2026年1月3日，我们在PubMed/MEDLINE、Embase和Cochrane中央对照试验登记处中检索了比较全身麻醉（GA）与非全身麻醉（非GA）策略在成年急性缺血性卒中（AIS）患者血管内治疗（EVT）中的随机对照试验（RCTs）。

Primary outcomes were functional independence (modified Rankin Scale [mRS] 0-2) at 90 days, successful reperfusion (thrombolysis in cerebral ischemia 2b-3), and 90-day mortality.

主要结果是在90天时的功能独立性（改良Rankin量表[mRS] 0-2）、成功的再灌注（脑缺血溶栓2b-3级）以及90天的死亡率。

Bayesian random-effects meta-analyses with weakly informative priors were performed.

使用具有弱信息先验的贝叶斯随机效应元分析进行分析。

Results are reported as odds ratio (OR) or mean difference (MD) with 95% credible intervals (CrIs).

结果以优势比(OR)或均值差(MD)报告，并附有95%可信区间(CrIs)。

A posterior probability of superiority exceeding 80% was considered substantial evidence of benefit.

后验概率超过80%表明具有显著的优越性证据。

Meta-regression and sensitivity analyses were conducted.

进行了元回归和敏感性分析。

Results

Ten RCTs (n = 1,601; mean age 70.0 years; 46.6% female) were included.

纳入了十项随机对照试验（n = 1,601；平均年龄70.0岁；女性占46.6%）。

For functional independence, GA was associated with a 94.2% posterior probability of superiority (OR 1.24, 95% CrI 0.94-1.66).

在功能独立性方面，全身麻醉与94.2%的优越性后验概率相关（比值比1.24，95%可信区间0.94-1.66）。

GA was associated with higher successful reperfusion rates (OR 1.73, 95% CrI 1.23-2.43; P (superiority) > 99%).

全身麻醉与更高的成功再灌注率相关（比值比1.73，95%可信区间1.23-2.43；优越性P值>99%）。

No substantial differences were observed for 90-day mortality (OR 0.92, 95% CrI 0.67-1.27; P [superiority] 69%), excellent functional outcome (mRS 0-1; OR 1.06, 95% CrI 0.80-1.41; P [superiority] 67%), or symptomatic intracranial hemorrhage (OR 0.93, 95% CrI 0.56-1.52; P [superiority] 62%).

对于90天死亡率（OR 0.92，95% CrI 0.67-1.27；P [优越性] 69%）、优秀功能结果（mRS 0-1；OR 1.06，95% CrI 0.80-1.41；P [优越性] 67%）或症状性颅内出血（OR 0.93，95% CrI 0.56-1.52；P [优越性] 62%）未观察到显著差异。

GA was associated with increased intraoperative hypotension (OR 4.28, 95% CrI 2.35-7.86; P [superiority] 0.01%) and increased pneumonia risk (OR 1.60, 95% CrI 0.95-2.81; P [superiority] 3%).

全身麻醉与增加的术中低血压（OR 4.28，95% CrI 2.35-7.86；P [优越性] 0.01%）和增加的肺炎风险（OR 1.60，95% CrI 0.95-2.81；P [优越性] 3%）有关。

Discussion

This meta-analysisusing a Bayesian approach provides evidence that GA during EVT for AIS is associated with improved functional outcomes, challenging previous conclusions of equivalence.

这项使用贝叶斯方法的荟萃分析提供了证据，表明在急性缺血性卒中(AIS)的血管内治疗(EVT)期间使用全身麻醉(GA)与改善功能结果相关，挑战了之前关于等效性的结论。

These findings should be interpreted considering open-label designs and heterogeneous non-GA comparators.

在解释这些发现时，应考虑开放标签设计和异质性非GA对照物。

They suggest that GA may be preferred but confirmatory evidence is needed.

他们建议，尽管需要确认性证据，但可能更倾向于选择全身麻醉（GA）。