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Anaesthesia-related complications after endovascular therapy for acute ischaemic stroke under general anaesthesia with early extubation: A single-centre retrospective cohort study

Year: 2026

Type: article

Abstract: Background The optimal anaesthetic strategy for endovascular therapy (EVT) in acute ischaemic stroke (AIS) remains debated. We evaluated the incidence of anaesthesia-related complications, their predictors, and the associated clinical outcomes of a standardised general anaesthesia (GA) protocol. Methods We retrospectively analysed patients undergoing EVT for AIS under GA over a 4-yr period. Patients were classified as having a complicated or uncomplicated course based on anaesthesia-related complications within 24 h post-EVT, defined as transfer from the angiography suite to the intensive care unit (ICU), prolonged stay at the post anaesthesia care unit (PACU), PACU-to-ICU transfer, or ICU transfer from the stroke ward. Predictors of a complicated course were analysed. The primary outcome was complication incidence. Secondary outcomes were 3-month functional outcome (modified Rankin Scale [mRS] 0–2 vs 3–6), change in 24-h National Institutes of Health Stroke Scale (NIHSS), pneumonia rate, and 3-month mortality. Results Of 734 patients, 133 (18%) experienced an anaesthesia-related complication and had a complicated course. Admission NIHSS, younger age, and posterior circulation occlusion were the strongest predictors. These patients had smaller 24-h NIHSS improvement (mean difference 5.4, 95% confidence interval [CI] 4.1–6.7), higher pneumonia risk (odd ratio [OR]: 2.72, 95% CI: 1.66–4.48), poorer functional outcomes (mRS: 3–6; OR: 3.65, 95% CI: 2.15–6.20), and higher mortality (OR: 4.20, 95% CI: 2.45–7.21) compared with those with an uncomplicated course. Conclusions Complications occurred in 133 (18%) patients and were more frequent in those with higher NIHSS scores and posterior circulation occlusions. Patients with a complicated course had poorer functional outcomes at 3 months.

Source: BJA Open

DOI: 10.1016/j.bjao.2026.100547