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Research Article: General anesthesia vs. non-general anesthesia for elderly stroke patients treated with mechanical thrombectomy

Date Published: 2026-03-12

Abstract:
This study aimed to compare the impact of general anesthesia (GA) versus non-GA on functional outcomes in elderly patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke. A total of 707 elderly stroke patients (mean age 74.7?±?6.8?years; 57.0% male) who received EVT were retrospectively analyzed. Patients were stratified into GA (48.1%) and non-GA (51.9%) groups. The primary outcome was the rate of good functional outcome, defined as a modified Rankin Scale (mRS) score of 0–2 at 90?days. Secondary outcomes included successful reperfusion (mTICI 2b-3), symptomatic intracerebral hemorrhage (sICH), early neurological deterioration, post-stroke pneumonia, mortality, and median mRS score at 90?days. Baseline characteristics were comparable between the GA and non-GA groups, except for a marginally longer onset to groin puncture time in the GA group ( p =?0.092). The primary outcome of good functional recovery at 90?days was not significantly different between the GA and non-GA groups (46.8% vs. 44.1%; adjusted odds ratio [aOR] 1.359, 95% confidence interval [CI] 0.913–2.022; p =?0.131). No significant differences were observed in successful reperfusion, sICH, early neurological deterioration, mortality, or median mRS scores. However, the GA group had a significantly higher incidence of post-stroke pneumonia compared to the non-GA group (37.9% vs. 27.5%; aOR 1.668, 95% CI 1.197–2.325; p =?0.003). In elderly stroke patients undergoing EVT, the type of anesthesia was not associated with significant differences in 90-day functional outcomes. However, GA was linked to a higher risk of post-stroke pneumonia.

Introduction:
Acute ischemic stroke represents a major cause of mortality and long-term disability worldwide, particularly among the elderly ( 1 , 2 ). Endovascular thrombectomy (EVT) has become the standard of care for eligible patients with large vessel occlusion ( 3 ). However, the optimal choice of anesthesia modality for EVT remains a subject of debate ( 4 , 5 ). General anesthesia (GA) may offer better procedural conditions by minimizing patient movement, yet it carries potential risks such as hemodynamic instability and…

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