Association between extubation timing and functional outcomes in patients with acute ischemic stroke after endovascular treatment

Introduction: General anesthesia (GA) with endotracheal intubation is standard during endovascular treatment (EVT) for acute ischemic stroke (AIS), but the optimal timing for post-procedural extubation remains unclear. Methods: In this retrospective cohort study, we analyzed data from 372 patients who underwent EVT under GA at our center. Extubation failure was defined as re-intubation within 48 hours of extubation. Continuous variable extubation timing was categorized using thresholds of 4, 6, 8 and 24 h for analysis. Poor outcome was defined as modified Rankin Scale ≥3 at discharge and 90 days. Results: Successful extubation was associated with favorable outcomes (P<0.001). Among patients with successful extubation, delayed extubation beyond 24 h was associated with poor outcomes compared with extubation within 24 h (P<0.001). The timing of extubation within the first 24 h showed distinct associations with outcomes. Extubation performed at 8–24 h was associated with poor outcomes both at 90 days (odds ratio [OR] 2.179, 95% confidence interval [CI] 1.124–4.223, P=0.021) and at discharge (OR 2.015, 95% CI 1.065–3.811, P=0.031) compared with extubation within 8 h. Comparisons of extubation at 4–24 h versus ≤4 h and 6–24 h versus ≤6 h showed no similar association. Conclusion: Successful extubation was associated with favorable outcomes in AIS patients undergoing EVT under GA. Within the first 24 hours, extubation ≤8 h was associated with better outcomes than extubation at 8–24 h. However, extubation at ≤4 h versus 4–24 h, or ≤6 h versus 6–24 h, was not associated with better outcomes.