Early vs Delayed Extubation After Thrombectomy in Stroke

Key Takeaways

• Recovery rates at 90 days were similar with extubation before 6 hours and with extubation at 6 to 12 hours.
• No significant between-group differences were seen in overall modified Rankin Scale distribution, hospital stay, complications, or 90-day mortality.
• Pneumonia was numerically lower and reintubation numerically higher with earlier extubation, but both comparisons were imprecise.

Whether patients recover better if extubated sooner after successful thrombectomy was tested in the EDESTROKE trial, which compared two postprocedure windows. Functional independence at 90 days was 47.7% in the early-extubation group and 45.9% in the delayed group, with RR 1.04 and 95% CI 0.76-1.43. The randomized trial asked whether extubation within 6 hours, rather than at 6 to 12 hours, could improve recovery after acute ischemic stroke treated under general anesthesia. Because all participants had undergone successful thrombectomy, the comparison focused on airway management timing after reperfusion rather than on the endovascular procedure itself. Earlier extubation did not improve 90-day functional independence.

Investigators conducted a randomized clinical trial at a single tertiary academic referral center, enrolling adults with acute ischemic stroke from anterior circulation large-vessel occlusion. Eligible patients had undergone successful endovascular thrombectomy under general anesthesia and were assigned 1:1 to extubation within 6 hours or between 6 and 12 hours. Enrollment ran from April 2023 through June 2025, and 174 patients were randomized, with 87 assigned to each group. The cohort had a median age of 76 years, 56.3% were women, and trial registration was NCT05847309. Follow-up continued for 90 days, and the primary endpoint was functional independence, defined as a modified Rankin Scale score of 0 to 2.

Broader efficacy measures also tracked closely between groups, with no significant difference in ordinal modified Rankin Scale distribution. The generalized odds ratio was 0.93, with 95% CI 0.66-1.31. Hospital utilization was also similar, with a median length of stay of 6 days in both groups. IQRs were 3 to 9.5 days in the early group and 4 to 10 days in the delayed group, with a median difference of 0.0 days. The 95% CI for that difference ranged from -1.81 to 1.81 days, and functional and utilization outcomes remained closely aligned across the two timing windows.

Respiratory safety outcomes were also similar overall, although the point estimates moved in different directions across endpoints. Pneumonia occurred in 21.8% of the early-extubation group and 29.9% of the delayed group, with RR 0.73 and 95% CI 0.44-1.22. Reintubation occurred in 4.6% and 2.3%, respectively, with RR 2.00 and 95% CI 0.37-10.9. Mortality at 90 days was 23.3% versus 22.4%, with RR 1.04 and 95% CI 0.60-1.81, and overall complications and mortality were similar between groups. In this single-center protocol, extubation within 6 hours did not improve functional independence compared with extubation at 6 to 12 hours.