Endovascular thrombectomy (EVT) has been proven as the standard treatment for acute ischemic stroke (AIS) patients due to large vessel occlusion (LVO). However, the ideal anesthetic strategy during EVT still remains unclear. Therefore, this systematic review and meta-analysis aimed to determine the optimal anesthetic modality for patients with AIS undergoing EVT based on current randomized controlled trials (RCTs).The databases Medline (via PubMed), EMBASE, Web of Science, and the Cochrane Library were searched for RCTs comparing general anesthesia (GA) and conscious sedation (CS) in AIS patients undergoing EVT. The primary outcome was a favorable functional outcome at 90 days postintervention. Data analysis was conducted using the Review Manager software (RevMan V.5.3).Eight RCTs involving 1199 patients were included. There was no significant difference between GA and CS group in the rate of functional independence (risk ratio [RR]: 1.10, 95% confidence interval [CI]: 0.96-1.25; P=0.17; I2=30%). Compared with the CS group, the GA group attained a higher successful recanalization rate (RR: 1.14, 95% CI: 1.08-1.20; P＜0.00001; I2 = 17%). In addition, patients in the GA were associated with a higher rate of hypotension (RR:1.87, 95% CI: 1.44-2.41; P＜0.00001; I2=66%) and a higher incidence of pneumonia (RR:1.38, 95% CI: 1.05-1.8; P=0.02; I2=37%).For AIS patients receiving EVT, the choice of anesthetic modality did not influence the 3-month neurological outcome while GA is superior to CS in terms of successful reperfusion rate. Moreover, the patients in the GA group were at a higher risk of developing hypotension and pneumonia. Further studies are required to provide more sufficient evidence.