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.