Effect of Anesthesia on Functional Outcomes in Acute Ischemic Stroke Patients Undergoing Thrombectomy with the RECO Device

BACKGROUND Given the ongoing uncertainty regarding the optimal anesthetic approach for mechanical thrombectomy, this study compared outcomes in patients with acute ischemic stroke (AIS) receiving local anesthesia (LA) versus general anesthesia (GA) for mechanical large-vessel thrombectomy using the RECO device. MATERIAL AND METHODS This study used data from the prospective multicenter RECO Study (266 patients: 119 LA, 147 GA). AIS was clinically and radiologically confirmed, with large-vessel occlusion verified by multimodal neuroimaging. All procedures utilized the RECO device via standard transfemoral approach. Primary outcomes included 90-day functional independence (modified Rankin scale), successful reperfusion (modified thrombolysis in cerebral infarction, mTICI 2b-3), and symptomatic intracranial hemorrhage (sICH) rates. RESULTS The LA group had higher hospital transfer rates, lower intravenous thrombolysis use, higher median baseline National Institutes of Health Stroke Scale (NIHSS) score, and longer onset-to-door/puncture/reperfusion time. Reperfusion rates were similar, but GA showed lower sICH (3.8% vs 12.4%, P=0.016) and better functional independence (57.8% vs 38.7%, P=0.002). After propensity-matched analysis (30/group) confirmed superior GA functional independence (56.7% vs 26.7%, P=0.018) with comparable sICH. Multivariate analysis linked higher baseline NIHSS to poor outcome [adjusted odds ratio (OR) 1.079; 95% confidence interval (CI): 1.037-1.123; P<0.001), while GA showed marginal benefit (adjusted OR 0.557; 95% CI: 0.311-1.000; P=0.050). CONCLUSIONS GA may be associated with better 90-day functional independence compared to LA in patients with AIS following mechanical large-vessel thrombectomy using the RECO device. This finding needs to be further validated in prospective or randomized controlled studies.