Summary of findings 1. General anaesthesia compared to non‐general anaesthesia for acute ischaemic stroke endovascular treatment (early).
| General anaesthesia compared to non‐general anaesthesia for acute ischaemic stroke endovascular treatment (early) | ||||||
| Patient or population: acute ischaemic stroke endovascular treatment Setting: hospital Intervention: general anaesthesia Comparison: non‐general anaesthesia | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with non‐general anaesthesia | Risk with general anaesthesia | |||||
|
Functional outcome (continuous; mRS) Follow‐up: at discharge |
The mean functional outcome (continuous; mRS ≤ 2) was 3 | MD 0 (0.31 lower to 0.31 higher) | — | 90 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b,c | — |
|
Neurological impairment (NIHSS) Follow‐up: from 24 to 48 hours |
The mean neurological impairment (NIHSS) was 11.3 | MD 0.29 lower (1.18 lower to 0.59 higher) | — | 982 (7 RCTs) | ⊕⊕⊝⊝ Lowb,d | — |
|
Stroke‐related mortality Follow‐up: in hospital |
104 per 1000 | 102 per 1000 (54 to 191) | RR 0.98 (0.52 to 1.84) | 330 (3 RCTs) | ⊕⊕⊝⊝ Lowb,d | — |
|
All intracranial haemorrhage Follow‐up: in hospital |
165 per 1000 | 152 per 1000 (107 to 213) | RR 0.92 (0.65 to 1.29) | 693 (5 RCTs) | ⊕⊕⊝⊝ Lowb,d | — |
|
Target artery revascularisation (dichotomous; mTICI 2b–3) Follow‐up: 1 day after procedure |
757 per 1000 | 833 per 1000 (772 to 893) | RR 1.10 (1.02 to 1.18) | 982 (7 RCTs) | ⊕⊕⊕⊝ Moderated | — |
|
Time to revascularisation from groin puncture until arterial reperfusion (minutes) Follow‐up: 1 day after procedure |
The mean time to revascularisation from the groin puncture until the arterial reperfusion (minutes) was 71.4 | MD 2.91 higher (5.11 lower to 10.92 higher) | — | 498 (5 RCTs) | ⊕⊝⊝⊝ Very lowb,c,d | — |
|
Adverse events (haemodynamic instability) Follow‐up: 1 day after procedure |
98 per 1000 | 21 per 1000 (5 to 78) | RR 0.21 (0.05 to 0.79) | 229 (2 RCTs) | ⊕⊕⊝⊝ Lowe,f | — |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; MD: mean difference; mRS: modified Rankin Scale; mTICI: modified Thrombolysis in Cerebral Infarction; NIHSS: National Institutes of Health Stroke Scale; RCT: randomised controlled trial; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded one level due to high risk of reporting and other bias. bDowngraded one level due to imprecision: 95% CI consistent with possible benefit and harm. cDowngraded one level due to indirectness: population. dDowngraded one level due to high risk of performance, attrition, reporting and other bias. eDowngraded one level due to high risk of performance and attrition bias. fDowngraded one level due to inconsistency: substantial heterogeneity.