Effect of extubation timing on prognosis in patients with acute stroke undergoing mechanical thrombectomy under general anesthesia: A retrospective study.

BACKGROUND: The timing of extubation after general anesthesia (GA) in patients with acute ischemic stroke treated with mechanical thrombectomy (MT) is a significant issue. Prolonged duration of mechanical ventilation is considered to be an independent risk factor that negatively affects functional survival in patients receiving neurocritical care. This study evaluated the effect of time to extubation and the development of pneumonia on clinical prognosis after MT performed under GA. METHODS: This retrospective, single-center, observational study included patients ≥18 years of age who underwent MT under GA for acute ischemic stroke between January 2023 and May 2025. Patient data were retrospectively obtained from hospital records and supplemented, when necessary, with information from patients' relatives. Demographic data, lengths of intensive care unit and hospital stay, additional complications, neurological functional status (modified Rankin Scale [mRS]) at discharge, and mortality were examined. Patients were evaluated according to extubation timing, pneumonia, discharge mRS score (0-2, favorable; 3-6, unfavorable), and 30-day mortality using multivariate logistic regression analysis. RESULTS: Data from 119 patients (mean age, 70.3±13.6 years) were analyzed. Patients in whom time to extubation was >24 h were older (p=0.003), exhibited a lower pre-procedural Glasgow Coma Scale (GCS) score (p<0.001), and higher pneumonia and mortality rates (p<0.001). Logistic regression analyses revealed that time to extubation >24 h significantly increased the likelihood of an unfavorable mRS score and mortality (p<0.001). Lower pre-procedural GCS (odds ratio [OR] 0.64; p<0.001) and higher American Society of Anesthesiologists Physical Status (ASA-PS) classification (OR 27.966; p<0.002) scores significantly affected time to extubation. A high ASA-PS score was found to increase the probability of pneumonia by tenfold (95% confidence interval 1.1-100.9). Patients with pneumonia exhibited significantly higher mRS scores (p<0.001). CONCLUSION: Although the time to extubation had a significant impact on poor neurological prognosis and mortality in patients undergoing MT for acute stroke, the development of pneumonia appeared to be associated with unfavorable early neurological functional outcomes.