Abstract The optimal anesthetic strategy during mechanical thrombectomy (MT) for acute ischemic stroke (AIS) remains debated. While general anesthesia (GA) and non-GA approaches are widely used, the impact of emergency conversion (EC) from non-GA to GA is unclear. We evaluated outcomes of patients undergoing EC compared with those managed with primary GA or non-GA. We conducted a multicenter observational study of consecutive anterior circulation large vessel occlusion patients with pre-stroke modified Rankin Scale (mRS) ≤ 2 treated with MT between January 2022 and December 2023 across three centers. Patients were categorized as GA, non-GA, or EC. Inverse probability weighting (IPW) with multivariable adjustment was applied. The primary outcome was 90-day mRS shift; secondary outcomes included pneumonia and 3-month mortality. Among 669 patients, 399 (59.6%) underwent GA, 188 (28.1%) non-GA, and 82 (12.3%) EC. No significant differences were observed in 90-day functional outcomes for EC versus GA (adjusted common OR acOR 0.74; 95% CI, 0.48–1.14; p = 0.170) or EC versus non-GA (acOR 0.70; 95% CI, 0.40–1.20; p = 0.193). Compared with EC, non-GA patients had lower pneumonia risk (acOR 0.17; 95% CI, 0.07–0.45; p = 0.001), while GA was associated with reduced 3-month mortality (acOR 0.48; 95% CI, 0.28–0.85; p = 0.011). Emergency conversion was not linked to worse functional outcomes compared with GA or non-GA. However, EC was associated with higher pneumonia risk relative to non-GA and increased mortality compared with GA. Larger prospective studies are warranted to clarify the impact of EC during MT.
Merlino et al. (2026) studied this question.