ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
This article is part of the Research TopicQuality of Stroke Care: What Could Be Improved, and How? - Volume IIView all 22 articles
Effect of general anesthesia vs. local anesthesia and collateral status on outcomes in anterior circulation occlusion
Provisionally accepted
Guojie Chen1
Rundong Chen1
Tianxiang Gao2
Lijun Wang1
Hongye Xu1Wen Yin1Yu Gao1
Lei Zhang1
Yongxin Zhang1
Pengfei Xing1
Pengfei Yang1
Zifu Li1
Yongwei Zhang1
Jianmin Liu1*- 1Neurovascular Centre, Changhai Hospital, Naval Medical University, Shanghai, China
- 2Changhai Hospital, Shanghai, China
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Background and objectives The impact of anesthesia type on outcomes following endovascular thrombectomy (EVT) remains controversial. Collateral status assessed through perfusion imaging may provide critical insights for optimizing anesthesia strategies during EVT. Methods: In this retrospective cohort study,functional outcomes after EVT (measured by the modified Rankin Scale score) were compared between general anesthesia (GA) vs. local anesthesia (LA) using a propensity score-matched model. The association between the hypoperfusion intensity ratio (HIR, defined as Tmax>10s/Tmax>6s) and outcomes was evaluated through weighted multivariate logistic regression, with potential nonlinearity explored using restricted cubic spline (RCS) regression. To validate the findings, five analytical approaches were applied, including propensity score matching, multivariate logistic modeling adjusted for all covariates, inverse probability of treatment weighting (IPTW), and doubly robust estimations with and without adjustments for unbalanced covariates. Results: A total of 702 patients were included, with 327 (46.6%) receiving GA and 375 (53.4%) receiving LA. Propensity score matching achieved balanced baseline characteristics (p>0.05). Among patients with good collateral status (HIR<0.4), GA was associated with worse functional outcomes (mRS 0–2: 49% vs. 70%; OR 2.88, 95% CI: 1.29–6.43). In patients with poor collateral status, outcomes were comparable between GA and LA (mRS 0–2: 50% vs. 59%; OR 1.73, 95% CI: 0.92–3.27). All five statistical models yielded consistent results. Conclusions: There is an association between general anesthesia and poorer functional prognosis in patients with well-developed collateral circulation after endovascular thrombectomy (EVT). HIR may serve as a useful marker for anesthesia selection and triage in EVT. Classification of Evidence This study provides Class III evidence that use of GA is associated with worse functional outcome in patients with good collateral that undergoing EVT.
Keywords: Acute ischemic stroke, endovascular treatment, Anesthesia, Collateral status, propensityscore matching, Functional independence
Received: 13 Jul 2025; Accepted: 28 Oct 2025.
Copyright: © 2025 Chen, Chen, Gao, Wang, Xu, Yin, Gao, Zhang, Zhang, Xing, Yang, Li, Zhang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jianmin Liu, chstroke@163.com
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