Impact of Anesthesia Modality on Clinical Outcomes in Anterior Circulation Stroke Patients Undergoing Mechanical Thrombectomy: A Retrospective Propensity Score-Matched Analysis

Background/Objectives: The type of anesthesia in patients with acute stroke is still controversial. This study aimed to investigate the effect of anesthesia management on clinical outcomes in patients with anterior circulation stroke undergoing mechanical thrombectomy. Methods: In this observational, retrospective study, patients with acute anterior circulation stroke who underwent mechanical thrombectomy between January 2021 and March 2025 were retrospectively reviewed. Patients were divided into groups according to the type of anesthesia administered. Functional independence was assessed at 90 days using the modified Rankin Scale. A TICI of 2b or higher was defined as successful reperfusion. In the conscious sedation (CS) and general anesthesia (GA) groups, patients were analyzed based on baseline characteristics and clinical outcomes using Propensity Score Matching. Results: In the propensity score-matched cohort, there was no significant difference between the two groups in terms of good functional outcome (mRS ≤ 2) (p = 0.82). When compared by successful reperfusion rate (TICI 2b or higher), it was significantly higher in the GA group (p = 0.01). Conclusions: In this study, the use of GA resulted in higher recanalization rates in patients with anterior circulation stroke undergoing mechanical thrombectomy. However, no differences were observed between the GA and CS groups in terms of functional outcomes, mortality, or peri-procedural/post-procedural complications.