EDESTROKE
(2026)Objective
To evaluate whether early extubation (<6 hours) compared with delayed extubation (6-12 hours) after successful thrombectomy under general anesthesia improves 90-day functional outcomes.
Study Summary
• No significant difference in ordinal mRS distribution (generalized OR 0.93, 95% CI 0.66-1.31)
• Pneumonia occurred in 21.8% of early group vs 29.9% of delayed group (RR 0.73, 95% CI 0.44-1.22)
• 90-day mortality was 23.3% vs 22.4% (RR 1.04, 95% CI 0.60-1.81)
Intervention
Early extubation (<6 hours) vs delayed extubation (6-12 hours) following endovascular thrombectomy under general anesthesia
Inclusion Criteria
Adults (age ≥18 years) with acute ischemic stroke due to anterior circulation large-vessel occlusion who underwent successful endovascular thrombectomy under general anesthesia
Study Design
Arms: Early extubation (<6 hours) vs Delayed extubation (6-12 hours)
Patients per Arm: 87 per arm (86-87 analyzed)
Outcome
• Similar median hospital stay: 6 days in both groups (median difference 0.0 days, 95% CI -1.81 to 1.81)
• Pneumonia trended lower in early group: 21.8% vs 29.9% (RR 0.73, 95% CI 0.44-1.22)
• Reintubation: 4.6% early vs 2.3% delayed (RR 2.00, 95% CI 0.37-10.9)
• 90-day mortality similar: 23.3% vs 22.4% (RR 1.04, 95% CI 0.60-1.81)
Bottom Line
Among patients with acute ischemic stroke undergoing successful thrombectomy under general anesthesia, early extubation (<6 hours) did not improve functional independence at 90 days compared with delayed extubation (6-12 hours), with no significant differences in mRS distribution, hospital stay, complications, or mortality. An individualized approach to postprocedure airway management is recommended.
Major Points
- No significant difference in functional independence at 90 days between early (47.7%) and delayed (45.9%) extubation groups (RR 1.04, 95% CI 0.76-1.43)
- Ordinal analysis of mRS scores showed no significant difference between groups (generalized OR 0.93, 95% CI 0.66-1.31)
- Hospital length of stay was similar between groups with median of 6 days in both
- Pneumonia rates showed a non-significant trend toward lower incidence with early extubation (21.8% vs 29.9%, RR 0.73, 95% CI 0.44-1.22)
- Reintubation rates were low and similar between groups (4.6% vs 2.3%)
- 90-day mortality was nearly identical between groups (23.3% vs 22.4%)
- Results support an individualized approach to extubation timing rather than a protocolized early strategy
Study Design
- Study Type
- Randomized clinical trial
- Randomization
- Yes
- Blinding
- Not specified
- Sample Size
- 174
- Follow-up
- 90 days
- Centers
- 1
- Countries
- Not specified
Primary Outcome
Definition: Functional independence at 90 days (modified Rankin Scale score of 0-2)
| Control | Intervention | HR/OR | P-value |
|---|---|---|---|
| 39 of 85 (45.9%) | 41 of 86 (47.7%) | - (0.76 to 1.43) | Not significant |
Limitations & Criticisms
- Single-center study limiting generalizability
- Relatively small sample size (174 patients randomized, 171 analyzed)
- No information on blinding procedures
- Exclusion criteria not specified in the abstract
- Baseline characteristics not detailed in the abstract
- No pre-specified subgroup analyses reported
- Lack of power calculation details
- Wide confidence intervals for several outcomes suggesting imprecision
- Pneumonia definition and diagnostic criteria not specified
Citation
Taboada M, Estany-Gestal A, Fernández J, et al. Early vs Delayed Extubation After Thrombectomy for Acute Ischemic Stroke: The EDESTROKE Randomized Clinical Trial. JAMA Neurol. Published online March 30, 2026. doi:10.1001/jamaneurol.2026.0475