General anesthesia versus non-GA for endovascular thrombectomy of posterior circulation stroke: A five-year retrospective analysis of the impact on patient outcomes.
INTRODUCTION The optimal anesthesia strategy during endovascular thrombectomy (EVT) for posterior circulation acute ischemic stroke (PC-AIS) remains unclear. METHODS We conducted a 5-year retrospective cohort study of consecutive PC-AIS patients treated with EVT and categorized by anesthetic modality: general anesthesia (GA) or non-GA. The primary outcome was functional independence at 90 days, defined as a modified Rankin Scale (mRS) score of 0-2. Secondary outcomes included successful reperfusion (mTICI 2b-3) and 3-month mortality. Multivariable logistic regression was used to adjust for confounding factors. RESULTS Of 132 patients, 55 (41.7%) underwent EVT under GA. Good functional outcome was achieved in 61.5% of GA patients versus 47.9% of non-GA patients. However, after adjustment, GA was not independently associated with functional independence (adjusted OR 0.72, 95% CI 0.22-2.31;p = 0.571). Reperfusion rates were similar for both groups (successful reperfusion: GA 84.1% vs. non-GA 81.7%, p = 0.458) and mortality at 3 months did not differ significantly (GA: 18.2% vs. non-GA: 20.8%; adjusted OR 2.41, 95% CI 0.78-7.47; p = 0.127). DISCUSSION There is no significant difference in outcomes between patients with PC-AIS undergoing EVT with GA versus non-GA. These findings align with recent evidence, suggesting comparable functional, angiographic, and survival outcomes across anesthetic strategies, though limitations related to retrospective design and practice variability remain. CONCLUSION Anesthetic modality (GA vs. non-GA) does not significantly affect 3-month functional outcomes, successful reperfusion, or mortality during EVT for PC-AIS, supporting an individualized, patient- and procedure-based approach.