Impact of anesthesia methods on functional outcomes in patients with acute ischemic stroke undergoing mechanical...

The choice of anesthesia modality during mechanical thrombectomy (MT) for acute ischemic stroke remains debated. This study aimed to analyze the impact of anesthesia type on clinical outcomes following endovascular therapy (EVT).

This subgroup analysis of the ENCHANTED2/MT trial included patients with large vessel occlusion (LVO) acute ischemic stroke who achieved successful reperfusion (eTICI ≥2b). Patients were stratified by anesthesia type: general anesthesia (GA) or non-general anesthesia (Non-GA). The primary outcome was functional recovery, assessed by the distribution of scores on the modified Rankin Scale (mRS; range 0 [no symptoms] to 6 [death]) at 90 days. Efficacy was analyzed using ordinal logistic regression.

A total of 809 patients were included (GA: 344; Non-GA: 465). There was no significant between-group difference in the primary outcome of mRS score distribution. The incidence of postoperative pneumonia was significantly lower in the Non-GA group (adjusted odds ratio [aOR] 0.33, 95% CI 0.14-0.74; p = 0.008). Among patients with milder initial neurological deficits (admission NIHSS score <15), the Non-GA group had higher odds of achieving functional independence (mRS 0-2) at 90 days (aOR 1.71, 95% CI 1.00-2.91; p = 0.049); this association was not observed in patients with more severe deficits (NIHSS ≥15) (P for interaction = 0.05). No significant differences were found between groups in the rates of symptomatic intracranial haemorrhage, recurrent stroke, mortality, or in the level of reperfusion.

In patients undergoing mechanical thrombectomy for acute ischemic stroke, Non-GA may be associated with better functional outcomes in patients presenting with milder neurological deficits. GA was associated with an increased risk of postoperative pneumonia.