Abstract Number: Esoc2026a2320 Prognostic Factors for Successful Weaning From Mechanical Ventilation in Acute Ischemic Stroke Treated With Mechanical Thrombectomy

Abstract Background and aims Mechanical ventilation can be a life-saving intervention in selected patients with acute ischemic stroke; however, a subset of patients remains ventilator-dependent. We aimed to identify factors associated with successful weaning from mechanical ventilation in individuals treated with mechanical thrombectomy. Methods We conducted a single-center retrospective cohort study of consecutive patients with acute ischemic stroke treated with mechanical thrombectomy requiring mechanical ventilation, admitted to the stroke unit between January 1, 2018, and June 31, 2025. Patients successfully weaned from mechanical ventilation—defined as maintaining spontaneous breathing for at least 7 days after discontinuation—were compared with ventilator-dependent individuals using univariable analyses. Variables showing significant differences were included in a multivariable logistic regression model. Results Among 223 patients, weaning was successful in 72 (32.3%) and unsuccessful in 151 (67.7%). Significant differences between groups were observed for age, history of atrial fibrillation and chronic kidney disease, indications for intubation, timing of intubation relative to reperfusion therapy, number of mechanical thrombectomy passes, and the occurrence of parenchymal hemorrhage type 2. In multivariable analysis, younger age (OR 0.95 per year, 95% CI 0.92–0.98), intubation prior to reperfusion therapy (OR 2.97, 95% CI 1.26–7.00), and a lower number of thrombectomy passes (OR 0.57 per category 1/2/≥3, 95% CI 0.35–0.94) were independently associated with successful weaning.The final regression model demonstrated good discrimination (AUC = 0.77). Conclusions Age, timing of intubation, and the number of mechanical thrombectomy passes may aid early assessment of the likelihood of successful weaning from mechanical ventilation in patients with acute ischemic stroke. Conflict of interest Marcin Stańczak: nothing to disclose. Bartosz Jabłoński: nothing to disclose. Adam Wyszomirski: nothing to disclose. Bartosz Karaszewski: nothing to disclose