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<p>The optimal anesthetic strategy during mechanical thrombectomy (MT) for acute ischemic stroke (AIS) remains debated. While general anesthesia (GA) and non-GA approaches are widely used, the impact of emergency conversion (EC) from non-GA to GA is unclear. We evaluated outcomes of patients undergoing EC compared with those managed with primary GA or non-GA. We conducted a multicenter observational study of consecutive anterior circulation large vessel occlusion patients with pre-stroke modified Rankin Scale (mRS) ≤ 2 treated with MT between January 2022 and December 2023 across three centers. Patients were categorized as GA, non-GA, or EC. Inverse probability weighting (IPW) with multivariable adjustment was applied. The primary outcome was 90-day mRS shift; secondary outcomes included pneumonia and 3-month mortality. Among 669 patients, 399 (59.6%) underwent GA, 188 (28.1%) non-GA, and 82 (12.3%) EC. No significant differences were observed in 90-day functional outcomes for EC versus GA (adjusted common OR [acOR] 0.74; 95% CI, 0.48–1.14; <i>p</i> = 0.170) or EC versus non-GA (acOR 0.70; 95% CI, 0.40–1.20; <i>p</i> = 0.193). Compared with EC, non-GA patients had lower pneumonia risk (acOR 0.17; 95% CI, 0.07–0.45; <i>p</i> = 0.001), while GA was associated with reduced 3-month mortality (acOR 0.48; 95% CI, 0.28–0.85; <i>p</i> = 0.011). Emergency conversion was not linked to worse functional outcomes compared with GA or non-GA. However, EC was associated with higher pneumonia risk relative to non-GA and increased mortality compared with GA. Larger prospective studies are warranted to clarify the impact of EC during MT.</p>

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Outcomes of emergency conversion to general anesthesia during thrombectomy for anterior circulation stroke

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月12日

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  • Giovanni Merlino,
  • Fedra Kuris,
  • Giacomo Cesco,
  • Paolo Paone,
  • Dario Alimonti,
  • Luca Longhi,
  • Maurizio Passoni,
  • Paolo Gritti,
  • Yan Tereshko,
  • Carolina Gentile,
  • Francesco Janes,
  • Simone Lorenzut,
  • Roberto Marinig,
  • Vladimir Gavrilovic,
  • Cristian Deana,
  • Kyriakos Lobotesis,
  • Berry Stewart,
  • Soma Banerjee,
  • Matteo Foschi,
  • Simona Sacco,
  • Francesco Bax,
  • Thanh N. Nguyen,
  • Massimo Sponza,
  • Gian Luigi Gigli,
  • Lucio D’Anna,
  • Mariarosaria Valente

摘要

The optimal anesthetic strategy during mechanical thrombectomy (MT) for acute ischemic stroke (AIS) remains debated. While general anesthesia (GA) and non-GA approaches are widely used, the impact of emergency conversion (EC) from non-GA to GA is unclear. We evaluated outcomes of patients undergoing EC compared with those managed with primary GA or non-GA. We conducted a multicenter observational study of consecutive anterior circulation large vessel occlusion patients with pre-stroke modified Rankin Scale (mRS) ≤ 2 treated with MT between January 2022 and December 2023 across three centers. Patients were categorized as GA, non-GA, or EC. Inverse probability weighting (IPW) with multivariable adjustment was applied. The primary outcome was 90-day mRS shift; secondary outcomes included pneumonia and 3-month mortality. Among 669 patients, 399 (59.6%) underwent GA, 188 (28.1%) non-GA, and 82 (12.3%) EC. No significant differences were observed in 90-day functional outcomes for EC versus GA (adjusted common OR [acOR] 0.74; 95% CI, 0.48–1.14; p = 0.170) or EC versus non-GA (acOR 0.70; 95% CI, 0.40–1.20; p = 0.193). Compared with EC, non-GA patients had lower pneumonia risk (acOR 0.17; 95% CI, 0.07–0.45; p = 0.001), while GA was associated with reduced 3-month mortality (acOR 0.48; 95% CI, 0.28–0.85; p = 0.011). Emergency conversion was not linked to worse functional outcomes compared with GA or non-GA. However, EC was associated with higher pneumonia risk relative to non-GA and increased mortality compared with GA. Larger prospective studies are warranted to clarify the impact of EC during MT.