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

Objective 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. Methods 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. Results 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). Conclusion 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.