ABSTRACT NUMBER: ESOC2026A443 CLINICAL IMPACT OF MECHANICAL VENTILATION DURATION AFTER ENDOVASCULAR THROMBECTOMY ON FUNCTIONAL OUTCOMES IN PATIENTS WITH ACUTE ISCHEMIC STROKE

Abstract Background and aims The impact of general anesthesia with mechanical ventilation on clinical outcomes in patients with acute ischemic stroke (AIS) undergoing endovascular thrombectomy (EVT) remains controversial. This study aims to investigate the association between mechanical ventilation duration and clinical outcomes in AIS patients undergoing EVT, as well as identify predictors of prolonged mechanical ventilation duration. Methods Patients who underwent EVT between January 2016 and December 2024 were retrospectively retrieved. The primary outcome was functional independence defined as mRS 0–2 at 90 days. The secondary outcomes included NIHSS at 24 h after EVT, mRS at 24 h after EVT, mRS at discharge, rate of symptomatic intracranial hemorrhage (sICH), and mortality at 90 days. Propensity score matching (PSM) was utilized to minimize selection bias. Results A total of 825 patients were included in this study, after PSM, 334 patients in each group were included in the analysis. Our results indicated that patients with mechanical ventilation duration > 6h had a lower rate of functional independence at 90 days (30.2% vs. 52.1%, P<0.001). Additionally, the mechanical ventilation duration >6h group had higher mRS at 90 days (4.0 vs. 2.0), higher mRS at discharge (4.0 vs. 3.0), higher NIHSS score at 24 hours (18.0 vs. 12.0), higher risk of sICH (19.2% vs. 9.9%), and higher mortality at 90 days (36.5% vs. 13.8%). Conclusions Prolonged mechanical ventilation duration after endovascular thrombectomy in AIS patients is associated with unfavorable clinical outcomes. Pre-EVT infection and a higher baseline NIHSS score are identified as risk factors for prolonged mechanical ventilation duration. Conflict of interest Nothing to disclose