Anesthetic Strategy, Functional Outcomes, and Infectious Complications After Mechanical Thrombectomy for Acute...

Area of Science:

• Neurology
• Anesthesiology
• Critical Care Medicine

Background:

• The optimal anesthetic approach for mechanical thrombectomy (MT) in acute ischemic stroke (AIS) is debated.
• Randomized trials show similar outcomes for general anesthesia (GA) and conscious sedation (CS), but real-world data needs evaluation.
• Factors like stroke severity and airway management may influence outcomes differently between anesthetic strategies.

Purpose of the Study:

• To evaluate the association between anesthetic strategy (GA vs. CS) and outcomes after MT for AIS.
• To compare functional outcomes, mortality, and complication rates (infectious, hemorrhagic) between GA and CS groups.
• To explore the impact of extubation timing on outcomes in patients receiving GA.

Main Methods:

• Retrospective observational study of 257 adult AIS patients undergoing MT.
• Patients were managed under conscious sedation (CS) or general anesthesia (GA).
• Multivariable logistic regression analyzed associations with 90-day functional independence and mortality, adjusting for baseline and procedural factors.

Main Results:

• GA was used in 39.7% of patients, CS in 60.3%.
• Adjusted analyses showed GA associated with higher 90-day mortality (OR 4.39) and lower functional independence (OR 0.29).
• Pneumonia was more frequent with GA (49.0% vs. 26.5%). Delayed extubation in GA patients correlated with worse outcomes and increased complications.

Conclusions:

• General anesthesia was associated with poorer functional outcomes and increased mortality post-MT for AIS.
• Residual confounding and baseline stroke severity may influence these findings; prospective validation is required.
• Pneumonia and hemorrhagic complications, particularly with delayed extubation, may indicate higher risk for adverse outcomes.