{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T18:41:55Z","timestamp":1793817715422,"version":"4.6.1"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    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)\u2009\u2264\u20092 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\u20131.14;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.170) or EC versus non-GA (acOR 0.70; 95% CI, 0.40\u20131.20;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.193). Compared with EC, non-GA patients had lower pneumonia risk (acOR 0.17; 95% CI, 0.07\u20130.45;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001), while GA was associated with reduced 3-month mortality (acOR 0.48; 95% CI, 0.28\u20130.85;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.011). 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.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-39248-2","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:22:31Z","timestamp":1770898951000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes of emergency conversion to general anesthesia during thrombectomy for anterior circulation stroke"],"prefix":"10.1038","volume":"16","author":[{"given":"Giovanni","family":"Merlino","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fedra","family":"Kuris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Cesco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Paone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Alimonti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Longhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Passoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Gritti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Tereshko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Gentile","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Janes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Lorenzut","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Marinig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladimir","family":"Gavrilovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Deana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyriakos","family":"Lobotesis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berry","family":"Stewart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soma","family":"Banerjee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Foschi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Sacco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Bax","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanh N.","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Sponza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Luigi","family":"Gigli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucio","family":"D\u2019Anna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariarosaria","family":"Valente","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"issue":"7","key":"39248_CR1","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1177\/17474930241228956","volume":"19","author":"Y Jia","year":"2024","unstructured":"Jia, Y. et al. Type of anesthesia for endovascular therapy in acute ischemic stroke: A literature review and meta-analysis. Int. J. Stroke. 19 (7), 735\u2013746. https:\/\/doi.org\/10.1177\/17474930241228956 (2024).","journal-title":"Int. J. Stroke"},{"key":"39248_CR2","doi-asserted-by":"publisher","unstructured":"Shenhui, J., Wenwen, D., Dongdong, L. & Yelong, R. General anesthesia versus sedation for endovascular thrombectomy: Meta-analysis and trial sequential analysis of randomized controlled trials. Heliyon 10 (13). https:\/\/doi.org\/10.1016\/j.heliyon.2024.e33650 (2024).","DOI":"10.1016\/j.heliyon.2024.e33650"},{"key":"39248_CR3","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1001\/jamaneurol.2025.3775","volume":"82","author":"PR Chen","year":"2025","unstructured":"Chen, P. R. et al. SEGA Investigators. Sedation vs general anesthesia for endovascular therapy in acute ischemic stroke: the SEGA randomized clinical trial. JAMA Neurol. 82, 1265\u20131273. https:\/\/doi.org\/10.1001\/jamaneurol.2025.3775 (2025).","journal-title":"JAMA Neurol."},{"issue":"19","key":"39248_CR4","doi-asserted-by":"publisher","first-page":"1986","DOI":"10.1001\/jama.2016.16623","volume":"316","author":"S Sch\u00f6nenberger","year":"2016","unstructured":"Sch\u00f6nenberger, S. et al. Effect of conscious sedation vs general anesthesia on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy: A randomized clinical trial. JAMA - J. Am. Med. Association. 316 (19), 1986\u20131996. https:\/\/doi.org\/10.1001\/jama.2016.16623 (2016).","journal-title":"JAMA - J. Am. Med. Association"},{"issue":"6","key":"39248_CR5","doi-asserted-by":"publisher","first-page":"1601","DOI":"10.1161\/STROKEAHA.117.016554","volume":"48","author":"PL Hend\u00e9n","year":"2017","unstructured":"Hend\u00e9n, P. L. et al. General anesthesia versus conscious sedation for endovascular treatment of acute ischemic stroke: the anstroke trial (Anesthesia during Stroke). Stroke 48 (6), 1601\u20131607. https:\/\/doi.org\/10.1161\/STROKEAHA.117.016554 (2017).","journal-title":"Stroke"},{"issue":"4","key":"39248_CR6","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1001\/jamaneurol.2017.4474","volume":"75","author":"CZ Simonsen","year":"2018","unstructured":"Simonsen, C. Z. et al. Effect of general anesthesia and conscious sedation during endovascular therapy on infarct growth and clinical outcomes in acute ischemic stroke a randomized clinical trial. JAMA Neurol. 75 (4), 470\u2013477. https:\/\/doi.org\/10.1001\/jamaneurol.2017.4474 (2018).","journal-title":"JAMA Neurol."},{"issue":"2","key":"39248_CR7","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1161\/STROKEAHA.124.047714","volume":"56","author":"C Tabillon","year":"2025","unstructured":"Tabillon, C. et al. AMETIS Preplanned ancillary study: impact of agitation during mechanical thrombectomy under sedation. Stroke 56 (2), 517\u2013520. https:\/\/doi.org\/10.1161\/STROKEAHA.124.047714 (2025).","journal-title":"Stroke"},{"issue":"1","key":"39248_CR8","doi-asserted-by":"publisher","first-page":"I","DOI":"10.1177\/2396987321989865","volume":"6","author":"E Berge","year":"2021","unstructured":"Berge, E. et al. European stroke organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur. Stroke J. 6 (1), I\u2013LXII. https:\/\/doi.org\/10.1177\/2396987321989865 (2021).","journal-title":"Eur. Stroke J."},{"key":"39248_CR9","doi-asserted-by":"publisher","unstructured":"Turc, G. et al. European stroke organisation (ESO) - European society for minimally invasive neurological therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke. J. Neurointerv Surg. 15 (8). https:\/\/doi.org\/10.1136\/neurintsurg-2018-014569 (2023).","DOI":"10.1136\/neurintsurg-2018-014569"},{"issue":"1","key":"39248_CR10","doi-asserted-by":"publisher","first-page":"21","DOI":"10.15274\/INR-2014-10004","volume":"20","author":"MA Almekhlafi","year":"2014","unstructured":"Almekhlafi, M. A. et al. Not all successful angiographic reperfusion patients are an equal validation of a modified TICI scoring system. Interventional Neuroradiol. 20 (1), 21\u201327. https:\/\/doi.org\/10.15274\/INR-2014-10004 (2014).","journal-title":"Interventional Neuroradiol."},{"issue":"12","key":"39248_CR11","doi-asserted-by":"publisher","first-page":"E344","DOI":"10.1161\/STR.0000000000000211","volume":"50","author":"WJ Powers","year":"2019","unstructured":"Powers, W. J. et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke a guideline for healthcare professionals from the American heart association\/American stroke association. Stroke 50 (12), E344\u2013E418. https:\/\/doi.org\/10.1161\/STR.0000000000000211 (2019).","journal-title":"Stroke"},{"issue":"9216","key":"39248_CR12","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1016\/S0140-6736(00)02237-6","volume":"355","author":"PA Barber","year":"2000","unstructured":"Barber, P. A., Demchuk, A. M., Zhang, J. & Buchan, A. M. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet 355 (9216), 1670\u20131674. https:\/\/doi.org\/10.1016\/S0140-6736(00)02237-6 (2000).","journal-title":"Lancet"},{"key":"39248_CR13","doi-asserted-by":"crossref","unstructured":"Adams, H. P. et al. Classification of Subtype of Acute Ischemic Stroke Definitions for Use in a Multicenter Clinical Trial. http:\/\/ahajournals.org (1993).","DOI":"10.1161\/01.STR.24.1.35"},{"issue":"1","key":"39248_CR14","doi-asserted-by":"publisher","first-page":"122","DOI":"10.3174\/ajnr.A6321","volume":"41","author":"F Flottmann","year":"2020","unstructured":"Flottmann, F. et al. Emergency conversion to general anesthesia is a tolerable risk in patients undergoing mechanical thrombectomy. Am. J. Neuroradiol. 41 (1), 122\u2013128. https:\/\/doi.org\/10.3174\/ajnr.A6321 (2020).","journal-title":"Am. J. Neuroradiol."},{"issue":"1","key":"39248_CR15","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1161\/01.STR.0000105396.93273.72","volume":"35","author":"DL Brown","year":"2004","unstructured":"Brown, D. L., Johnston, K. C., Wagner, D. P. & Haley, E. C. Predicting major neurological improvement with intravenous Recombinant tissue plasminogen activator treatment of stroke. Stroke 35 (1), 147\u2013150. https:\/\/doi.org\/10.1161\/01.STR.0000105396.93273.72 (2004).","journal-title":"Stroke"},{"issue":"9","key":"39248_CR16","doi-asserted-by":"publisher","first-page":"2650","DOI":"10.1161\/STROKEAHA.113.001972","volume":"44","author":"OO Zaidat","year":"2013","unstructured":"Zaidat, O. O. et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: A consensus statement. Stroke 44 (9), 2650\u20132663. https:\/\/doi.org\/10.1161\/STROKEAHA.113.001972 (2013).","journal-title":"Stroke"},{"issue":"13","key":"39248_CR17","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1056\/nejmoa0804656","volume":"359","author":"W Hacke","year":"2008","unstructured":"Hacke, W. et al. Thrombolysis with Alteplase 3 to 4.5 hours after acute ischemic stroke. N. Engl. J. Med. 359 (13), 1317\u20131329. https:\/\/doi.org\/10.1056\/nejmoa0804656 (2008).","journal-title":"N. Engl. J. Med."},{"issue":"16","key":"39248_CR18","doi-asserted-by":"publisher","first-page":"E1655","DOI":"10.1212\/WNL.0000000000207066","volume":"100","author":"D Campbell","year":"2023","unstructured":"Campbell, D., Butler, E., Campbell, R. B., Ho, J. & Alan Barber, P. General anesthesia compared with Non-GA in endovascular thrombectomy for ischemic stroke: A systematic review and Meta-Analysis of randomized controlled trials. Neurology 100 (16), E1655\u2013E1663. https:\/\/doi.org\/10.1212\/WNL.0000000000207066 (2023).","journal-title":"Neurology"},{"issue":"5","key":"39248_CR19","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1161\/STROKEAHA.124.049358","volume":"56","author":"C Heitkamp","year":"2025","unstructured":"Heitkamp, C. et al. General anesthesia versus conscious sedation in thrombectomy patients with low NIHSS anterior circulation stroke. Stroke 56 (5), 1191\u20131199. https:\/\/doi.org\/10.1161\/STROKEAHA.124.049358 (2025).","journal-title":"Stroke"},{"key":"39248_CR20","doi-asserted-by":"publisher","unstructured":"Chen, M. et al. Emergency intubation during thrombectomy for acute ischemic stroke in patients under primary procedural sedation. Neurol. Res. Pract. 3 (1). https:\/\/doi.org\/10.1186\/s42466-021-00125-0 (2021).","DOI":"10.1186\/s42466-021-00125-0"},{"issue":"4","key":"39248_CR21","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1159\/000520929","volume":"51","author":"F Geraldini","year":"2022","unstructured":"Geraldini, F. et al. Risk factors for general anesthesia conversion in anterior circulation stroke patients undergoing endovascular treatment. Cerebrovasc. Dis. 51 (4), 481\u2013487. https:\/\/doi.org\/10.1159\/000520929 (2022).","journal-title":"Cerebrovasc. Dis."},{"issue":"2","key":"39248_CR22","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1007\/s12028-011-9638-0","volume":"16","author":"AE Hassan","year":"2012","unstructured":"Hassan, A. E. et al. Increased rate of aspiration pneumonia and poor discharge outcome among acute ischemic stroke patients following intubation for endovascular treatment. Neurocrit Care. 16 (2), 246\u2013250. https:\/\/doi.org\/10.1007\/s12028-011-9638-0 (2012).","journal-title":"Neurocrit Care"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-39248-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-39248-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-39248-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T09:57:38Z","timestamp":1773050258000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-39248-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,12]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["39248"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-39248-2","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,12]]},"assertion":[{"value":"19 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Soma Banerjee is a key opinion leader for RAPIDAI. Thanh N. Ngyen is Associate Editor of Stroke; advisory board for Brainomix, Aruna Bio; speaker for Genentech, Kaneka. All other authors have no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Given its retrospective design and the use of fully anonymized data collected during routine clinical care, the requirement for informed consent was waived in accordance with local regulations.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The study was conducted in accordance with the principles outlined in the Declaration of Helsinki. The protocol was approved by the local ethics committee of Udine University Hospital, the coordinating center (Ref. No. IRB: 106\u20132025).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"G.M.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}}],"article-number":"8450"}}