Search Results (335)

Background/Objectives: Anemia is frequently encountered in emergency departments (EDs). Although intravenous (IV) iron can be used as an alternative or adjunct to red blood cell (RBC) transfusion in selected hemodynamically stable patients, its use in the ED remains limited. This study described IV iron utilization and RBC transfusion patterns in ED patients with anemia and evaluated their associations with clinical outcomes. Methods: We conducted a single-center retrospective cohort study of patients who presented to a tertiary ED with hemoglobin (Hb) ≤ 10 g/dL between January 2019 and December 2021. Patients were categorized according to receipt of IV iron in the ED. Baseline characteristics, laboratory findings, transfusion practice, hospital length of stay (LOS), ICU admission, and in-hospital mortality were compared between groups. Results: Among 3340 patients, 89 (2.7%) received IV iron in the ED. IV iron recipients were older and had lower Hb levels than non-recipients. Gastrointestinal disorders were more frequent in the IV iron group (68.5% vs. 19.9%), and IV iron was commonly administered with ED RBC transfusion. ED transfusion (69.7% vs. 11.1%) and ICU admission (24.7% vs. 15.7%) were more frequent in the IV iron group. Among patients with available ferritin and transferrin saturation (TSAT), IV iron recipients had lower ferritin levels and more frequently showed ferritin-based or combined ferritin/TSAT findings suggestive of iron deficiency. In-hospital mortality was similar between groups (5.6% vs. 5.7%). Among hospitalized patients, median LOS was shorter in the IV iron group than in the non-IV iron group (6.6 vs. 9.7 days). Conclusions: IV iron was infrequently administered in ED patients with Hb ≤ 10 g/dL and was used mainly as an adjunct to RBC transfusion in older patients with gastrointestinal causes of anemia. Its association with shorter LOS should be interpreted cautiously. Structured ED-based anemia evaluation may help optimize IV iron use in selected patients. Full article

Background: Atrial septal defect (ASD) is common in adults and may cause chronic right ventricular (RV) volume overload and remodeling. Electrocardiography (ECG) may serve as a screening adjunct to echocardiography. Objectives: To evaluate the association of the terminal D1S + D3R ECG pattern, defined as a terminal S wave in lead I plus a terminal R wave in lead III, with structural and hemodynamic right heart involvement in adult secundum ASD. Methods: A total of 161 adult patients with secundum ASD were retrospectively analyzed. Right heart involvement was assessed using pulmonary-to-systemic flow ratio (Qp/Qs) ≥ 1.5 and a right ventricular/left ventricular (RV/LV) ratio > 1. ECG parameters, including right bundle branch block (RBBB), right axis deviation, V1–V2 R-wave positivity, and terminal D1S + D3R, were evaluated by two blinded cardiologists, with final classifications determined by consensus. Multivariable Firth penalized logistic regression, correlation analyses, and receiver operating characteristic (ROC) analyses were performed. Results: In the multivariable Firth penalized logistic regression model, pulmonary artery pressure (PAP) and ASD diameter were independently associated with Qp/Qs ≥ 1.5, whereas the terminal D1S + D3R pattern was not. The terminal D1S + D3R pattern was independently associated with RV dilatation after adjustment for age, sex, PAP, and ASD diameter (odds ratio [OR]: 9.90, 95% confidence interval [CI]: 2.82–38.20, p < 0.001) and showed good discriminatory performance for RV dilatation (area under the curve [AUC]: 0.881, 95% CI: 0.831–0.932). Conclusions: In adults with secundum ASD, a positive terminal D1S + D3R ECG pattern is independently associated with RV dilatation and may serve as a practical adjunctive screening marker. However, it should not replace echocardiographic assessment. Full article

Hybrid brain–computer interfaces (BCIs) have attracted growing research attention because they combine the millisecond-level temporal resolution of electroencephalography (EEG) with the spatially informative hemodynamic responses of functional near-infrared spectroscopy (fNIRS). However, most existing deep fusion methods rely on static late-fusion strategies, which tend to underexploit latent cross-modal dependencies and are vulnerable to modality-specific signal degradation. To address these limitations, we propose MGFNet, a multi-granularity fusion network for hybrid BCI decoding. MGFNet contains three components: (1) intra-modal encoders that learn modality-specific spatiotemporal representations from EEG, oxygenated hemoglobin (HbO), and deoxygenated hemoglobin (HbR) signals; (2) cross-modal interaction encoders that temporally align paired modalities and use dilated convolutions to capture long-range EEG-fNIRS dependencies; and (3) a Coupling-Guided Sparse Component Routing (CGSCR) module that estimates sample-specific cross-modal coupling and performs adaptive discrete routing. We further introduce a deep supervision strategy to stabilize optimization and improve branch-level discriminability. Under a within-subject held-out evaluation protocol on a public benchmark dataset, MGFNet achieved classification accuracies of 99.40% on the n-back task and 99.03% on the word generation (WG) task, outperforming representative comparison methods evaluated under a matched protocol. Ablation studies further confirmed the contributions of the intra-modal encoders, the cross-modal interaction encoders, and the CGSCR module. Under controlled EEG corruption with additive white Gaussian noise at −10 dB, MGFNet outperformed a static-fusion variant by 9.23 percentage points on the n-back task and 6.31 percentage points on the WG task. These results support the effectiveness of MGFNet in the present offline within-subject setting and indicate improved robustness under controlled single-modality degradation. Full article

Left atrial (LA) blood flow stasis is a major contributor to thromboembolic risk in atrial fibrillation (AF) and can be measured non-invasively using four-dimensional (4D) flow magnetic resonance imaging (MRI), yet factors driving impaired LA hemodynamics in paroxysmal AF remain unclear. In this retrospective study, 107 patients with paroxysmal AF undergoing pre-ablation cardiac MRI were evaluated. LA blood flow stasis was quantified as the proportion of LA voxels with velocity < 0.1 m/s on 4D flow MRI. Multivariable linear regression assessed associations between LA stasis and demographic, cardiac structural and functional, and clinical variables in a complete-case cohort of 88 patients. Mean LA blood flow stasis was 44 ± 13%. After adjustment, higher left atrial volume index, higher hematocrit, and female sex were independently associated with greater LA stasis, while higher left ventricular ejection fraction, higher resting heart rate, and higher body mass index were associated with lower stasis (all p < 0.01). Age and diabetes status were not significantly associated with stasis. The final model explained 40.8% of the variance in LA blood flow stasis. These results underscore the multifactorial nature of LA hemodynamic impairment in paroxysmal AF and support integrating clinical and imaging markers to refine thromboembolic risk assessment. Full article

Background/Objectives: Chronic intake for 7 to 14 days of anthocyanin-rich blackcurrant extract or powder has been shown to alter cardiorespiratory and metabolic responses during rest and moderate-intensity exercise. Whether the observed effects were due to the final intake on the day of testing is not known. We examined whether there were effects of an acute intake of blackcurrant extract on the cardiorespiratory and metabolic responses during supine rest and moderate-intensity treadmill walking. Methods: Healthy men (n = 15, age: 24 ± 6 years, body mass index: 24.4 ± 4.5 kg·m⁻²) volunteered in a randomized, cross-over designed exploratory study. Acute intake effects of blackcurrant extract (210 mg of anthocyanins) were compared to a control condition. Hemodynamic recordings and indirect calorimetry techniques were used to record physiological and metabolic responses during 10 min of supine rest and 30 min of moderate-intensity treadmill walking. Results: At rest, there may have been an effect for an increase in cardiac output (p = 0.088). Based on the smallest worthwhile change (i.e., 0.2 × the standard deviation in the control condition), eight participants were classified as responders with an increase in cardiac output of 13.5 ± 8.4% (range: 4.0 to 24.7%). For total peripheral resistance, a decrease was observed (p = 0.048, d = −0.40, small effect size), with nine participants classified as responders with a decrease of 17.5 ± 6.1% (range: −9.7 to −28.0%). No changes were observed for other cardiorespiratory and metabolic parameters during supine rest. During moderate-intensity exercise, only heart rate was lower by 2 beats·min⁻¹ for the cohort (d = −0.11, trivial effect size) with four participants considered responders when presenting a heart rate lower than the smallest worthwhile change of 3 beats·min⁻¹. Conclusions: An acute intake of a blackcurrant extract with 210 mg of anthocyanins may have had an effect on vascular regulation mechanisms affecting total peripheral resistance and cardiac output during rest in at least ~50% of the male participants. No acute effects were observed for metabolic responses during rest and exercise. Our findings regarding the metabolic effects are not consistent with previous chronic dosing studies suggesting that repeated daily intake with a dose of 210 mg of anthocyanins is needed to alter substrate oxidation at rest and during moderate-intensity exercise. Full article

Background: Noninvasive echocardiographic markers are widely used to estimate left ventricular filling pressure, but their relationship with directly measured left ventricular end-diastolic pressure (LVEDP) is often modest and context-dependent. Whether routinely available noninvasive findings reflect elevated LVEDP through an intermediate invasive pulmonary hemodynamic phenotype remains insufficiently characterized. Objective: To evaluate the relationship of noninvasive echocardiographic and laboratory markers with directly measured LVEDP and to determine whether invasive pulmonary artery diastolic pressure (dPAP) functions as a hemodynamic bridge linking upstream noninvasive findings to elevated left ventricular filling pressure in a routine catheterization cohort. Methods: This retrospective single-center observational study included patients undergoing routine cardiac catheterization with available direct LVEDP measurement and invasive pulmonary artery pressure data. Elevated LVEDP was defined as LVEDP ≥ 15 mmHg, and elevated dPAP as dPAP ≥ 24 mmHg. Noninvasive, bridge, and invasive validation models were evaluated using logistic regression, receiver operating characteristic analysis, calibration assessment, and bootstrap internal validation. Results: A total of 75 patients had direct LVEDP data, 94 had invasive dPAP data, 83 had echocardiographic systolic pulmonary artery pressure (echo-sPAP), and 37 had pulmonary capillary wedge pressure (PCWP) measurements. Patients with elevated LVEDP had significantly higher creatinine (p = 0.026), dPAP (p = 0.043), and PCWP (p = 0.004). Echo-sPAP showed good discrimination for elevated dPAP, with an AUC of 0.791 (95% CI 0.695–0.888), supporting its role as an upstream noninvasive marker of invasive pulmonary hemodynamic burden. A noninvasive model combining echo-sPAP and creatinine showed modest discrimination for elevated LVEDP (AUC 0.664, 95% CI 0.522–0.806; Brier score 0.198), whereas an invasive validation model combining dPAP and creatinine showed better performance (AUC 0.734, 95% CI 0.617–0.850; Brier score 0.176). In bootstrap validation, the optimism-corrected AUCs were approximately 0.624 and 0.711, respectively. Although the invasive model performed numerically better, DeLong comparison did not show a statistically significant difference between the two models (p = 0.459). Conclusions: Routinely available noninvasive echocardiographic and laboratory findings appear to relate to directly measured left ventricular filling pressure through an intermediate invasive pulmonary hemodynamic pattern. Echo-sPAP showed its strongest signal at the level of elevated dPAP, whereas dPAP combined with creatinine provided the most informative model for elevated directly measured LVEDP. These findings support a hypothesis-generating hemodynamic framework linking noninvasive assessment to directly measured filling pressure and may help inform noninvasive hemodynamic triage and physiological risk enrichment in selected clinical settings. Full article

Background/Objectives: Postoperative agitation (PA) and postoperative pain in pediatric patients following sevoflurane anesthesia are challenging clinical scenarios. This study aimed to evaluate the effects of intraoperative dexmedetomidine infusion compared to fentanyl infusion on the prevention of postoperative agitation and analgesic efficacy in children undergoing tonsillectomy and/or adenoidectomy. Methods: After ethical committee approval, a total of 85 pediatric patients (age range: 2–13 years) in the ASA I-II group were included in the study. Patients were randomized into two groups: the dexmedetomidine group (Group D, n = 40) and the fentanyl group (Group F, n = 45). Postoperative pain was monitored in the recovery unit (PACU) using the FLACC (face, legs, activity, cry, consolability) scale, and agitation was monitored using the PAED (pediatric anesthesia emergence delirium) scale. FLACC and PAED were monitored at 5, 10, 15, 30 min, and 2 and 4 h postoperatively. Results: Demographic data and surgical durations were similar between groups (p > 0.05). The dexmedetomidine group had lower FLACC pain scores at 10 and 15 min (uncorrected trends), but only the difference at 30 min remained statistically significant after Bonferroni correction (p = 0.0001; Cohen’s d = 0.85). Although PAED scores were numerically lower in Group D, no statistically significant difference was found. While an observational trend toward lower agitation was noted, it did not reach statistical significance. Extubation times and hemodynamic parameters were similar in both groups. Conclusions: The intraoperative use of dexmedetomidine in tonsillectomy and adenoidectomy procedures provides superior analgesia compared to fentanyl, particularly in the first 30 min postoperatively, without prolonging recovery time. Full article

Exercise training improves maximum aerobic capacity, in part, through improvements in skeletal muscle function. This study aimed to investigate adaptations to improved aerobic capacity training through non-invasive and non-exhaustive tests of hyperemic muscle blood flow and near-infrared spectroscopy (NIRS) muscle oxygenation kinetics. An experimental study was conducted on 18 participants (age, 28.2 ± 5.3 yr; _absVO_2max, 3.60 ± 0.67 L·min⁻¹). Before and after the intervention of a 6-week of high-intensity interval training (HIIT), participants underwent three tests: (1) a graded cardiopulmonary exercise test; (2) a vascular occlusion test; and (3) a steady-state exercise (SSE) at 60% of PPO. Expired gas analysis, superficial femoral blood flow (occlusion test only) and SmO₂ kinetics were measured. The intervention increased maximal aerobic capacity _absVO_2max (p < 0.001, d = 0.65) and PPO (p < 0.001; d = 0.41). Moreover, steady-state _absVO₂ (p = 0.006; d = 0.37) and HR (p = 0.001; d = 0.65) were reduced. With the cuff test, the SmO₂ desaturation slope increased (p = 0.04; d = 0.52), while peak muscle blood flow (p = 0.02; d = 0.51) and the SmO₂ 10 s reoxygenation rate increased (p < 0.001 d = 1.11; 0.74 ± 0.28 to 1.17 ± 0.45%/s). During steady-state exercise, SmO₂ decreased less (p = 0.02; d = 0.43), and the 10s recovery kinetics rate was slowed (p = 0.01 d = 0.30; 0.28 ± 0.20 to 0.22 ± 0.21%/s). The improvement in VO_2max had a moderate correlation with the SmO₂ recovery rate post-steady-state exercise (p = 0.05, r = −0.54). HIIT changed maximal aerobic capacity alongside improvements in skeletal muscle hyperemic blood flow, SmO₂ post-occlusive reactive hyperemia and SmO₂ post-exercise recovery kinetics. Thus, the findings indicated that non-invasive and non-exhaustive hemodynamic kinetic profiles can monitor adaptations to improved aerobic capacity. Full article

Background: Endovascular aortic aneurysm repair (EVAR) is considered the gold standard for the treatment of abdominal aortic aneurysms. However, the performance of stent-grafts used during this procedure may be affected by their structural design, particularly in anatomically challenging, tortuous iliac arteries. This study aimed to evaluate the hemodynamic performance of different stent-graft limb designs in an in vitro EVAR simulation using compliant three-dimensional (3D)-printed iliac artery models with controlled angulations. Methods: Four commercially available stent-grafts (Anaconda^®, Endurant II^®, Treo^®, Zenith Spiral-Z^®) representing different stent-strut configurations (including O-ring, Z-stent, and spiral designs) were deployed in compliant 3D-printed vascular phantoms simulating severe iliac angulations of 75°, 90°, and 105°. The models were incorporated into a pulsatile flow circuit, and pressure and flow velocity were measured proximally and distally to the angulated segment. Results: Across all tested angulations, the O-ring-based design demonstrated the most favorable hemodynamic performance. In particular, the Anaconda stent-graft showed the smallest pressure loss and the lowest increase in distal flow velocity, especially in the 90° and 105° models. These findings suggest that O-ring-supported structures provide greater flexibility and conformability in severely angulated iliac segments. Conclusions: In this controlled in vitro setting, stent-grafts with O-ring strut morphology better preserved flow conditions than other tested configurations in tortuous anatomy. These results suggest that stent-graft structural design may influence device behavior in challenging iliac anatomy under controlled in vitro conditions. These findings should be considered hypothesis-generating bench data and do not represent direct evidence for clinical device selection. Full article

Background/Objectives: Nutritional strategies targeting redox and immune pathways may help to stabilize redox hemodynamics and support immune competence. Controlled physiological stress models allow examination of how nutrients influence dynamic antioxidant and inflammatory responses. Methods: In this randomized, double-blind, placebo-controlled trial (RCT), 39 healthy, moderately active men (supplement group: n = 20; placebo group: n = 19) received a yeast cell-derived formulation containing β-glucans and micronutrients or placebo for 8 weeks. Two standardized high-intensity interval training (HIIT) sessions (PRE/POST) transiently induced oxidative and inflammatory stress. Outcomes included reactive oxygen species (ROS; whole-blood EPR), total antioxidant capacity (FRAP), superoxide dismutase (SOD), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and upper respiratory tract infection (URTI) incidence and duration. Results: Prior to the intervention period, acute supplement intake resulted in a more pronounced reduction in ROS from 0′ to 60′ compared with placebo (−6.2%; p ≈ 0.14). After eight weeks, fasting FRAP increased only in the supplemented group (p < 0.01). Mixed-model repeated-measures ANOVA demonstrated significant time × group interactions for FRAP in both PRE and POST assessments, indicating differential temporal trajectories. The chronic FRAP increase correlated with the acute ROS reduction (p < 0.05; r² = 0.21). SOD activity was higher in the supplemented group at 60′ in the POST assessment (p < 0.05), and a significant time × group interaction was observed for SOD in POST. TNF-α decreased across the intervention in participants with elevated baseline values, whereas individuals with low initial concentrations showed no change. The supplemented group reported shorter URTI duration (−1.4 days; d = 0.34) and fewer prolonged episodes (>10 days: 5% vs. 15.8%), although these differences were not statistically significant. Conclusions: Eight weeks of supplementation with a yeast cell-derived formulation containing β-glucans and micronutrients was associated with differences in selected redox-related markers, including FRAP and SOD, without altering exercise-induced ROS dynamics. The observed patterns suggest subtle modifications in antioxidant-related response characteristics under standardized physiological stress. These findings warrant further investigation in larger and more heterogeneous cohorts, particularly in populations exposed to higher oxidative or inflammatory burden. Full article

Hemodynamic analysis of blood flow is critical for diagnosing cardiovascular diseases and investigating cardiovascular parameters, such as aneurysms and wall shear stress. For subject-specific analyses, the anatomy and blood flow of the subject can be captured non-invasively using structural and 4D Magnetic Resonance Imaging (MRI), respectively. Computational fluid dynamics (CFD), on the other hand, can be used to generate blood flow simulations. To generate and analyze subject-specific blood flow simulations, MRI and CFD have to be brought together. We present an interactive, customizable, and user-oriented visual analysis tool that integrates measured data and CFD simulations. Thus, our open-source tool supports both medical and numerical analysis workflows. It enables the creation of simulation ensembles with a high variety of parameters. Furthermore, it allows for visual and analytical examination of simulations and measurements through 2D embeddings. To demonstrate the effectiveness of our tool, we applied it to three real-world use cases, showcasing its ability to configure simulation ensembles and analyze blood flow. We evaluated our example cases together with MRI and CFD experts. By combining the strengths of both CFD and MRI, our tool provides a comprehensive understanding of hemodynamic parameters, facilitating accurate analysis of hemodynamic biomarkers. Full article

Background: Objective performance assessment is essential in surgical skill training, yet current methods are labor-intensive and focus on observing the trainee rather than the end-product of the procedure. Machine learning (ML) methods offer reproducible feedback but have mainly relied on kinematic or video data, often reducing assessment to binary or ternary classification. Our objective was to compare ML regression models predicting expert-assigned scores of vascular anastomoses from computational fluid dynamics (CFD) features of the final product. Additionally, we aimed to assess biomechanical plausibility of predictions. Methods: A total of 146 participants performed 419 end-to-side anastomoses on case-specific three-dimensional (3D) printed simulators. Anastomoses were digitized via 3D scanning, ranked by experts, and characterized using CFD-derived hemodynamic features. These served as input for linear models (Ridge, Partial Least Squares), support vector machines, and tree-based ensembles (Random Forest, Extremely Randomized Trees, and Extreme Gradient Boosting [XGBoost]), evaluated using 10-fold nested cross-validation with genetic hyperparameter optimization. Results: Inter-rater reliability of expert indicated strong agreement (intraclass correlation coefficient ICC3k = 0.846). XGBoost achieved the lowest mean root mean squared error of 0.758 (95% bootstrap CI: 0.722–0.799) and a coefficient of determination (R²) of 0.673 (0.617–0.725), with the most stable performance across folds. Shapley additive explanations (SHAP) identified the wall shear stress gradient, transverse wall shear stress, and maximum pressure as the most influential features—variables associated with intimal hyperplasia and atherosclerotic remodeling. Conclusions: Tree-based ensemble methods, particularly XGBoost, effectively modeled biomechanical properties against expert scores. Combining CFD and ML can provide reproducible, mechanistically relevant feedback in vascular surgical skill training. Full article

Pulmonary embolism (PE) remains a frequent and potentially fatal condition, with early mortality largely driven by (RV) failure and hemodynamic collapse. Rapid and accurate prognostic assessment is therefore central to management. Current European Society of Cardiology (ESC) strategies rely first on hemodynamic status to identify high-risk patients requiring urgent reperfusion consideration, and then—when patients are normotensive—on a stepwise approach combining clinical risk scores, RV imaging, and circulating biomarkers. Clinical tools such as HESTIA and the Pulmonary Embolism Severity Index (PESI)/simplified PESI (sPESI) enable early identification of low-risk patients suitable for outpatient pathways and stratify 30-day mortality risk, but do not integrate biological data. Consequently, biomarkers have an expanding role in refining prognosis, particularly within the heterogeneous intermediate-risk group. This review provides a practical overview of established and emerging biomarkers for PE risk stratification. Conventional cardiac biomarkers—troponins and natriuretic peptides (BNP/NT-proBNP)—reflect RV myocardial injury and strain and, when combined with imaging evidence of RV dysfunction, allow discrimination between intermediate–low- and intermediate–high-risk PE, guiding monitoring intensity and escalation strategies. D-dimer, while essential in diagnostic algorithms because of its high negative predictive value, has only an adjunctive and indirect prognostic role. Beyond these markers, growing evidence supports additional biomarkers capturing complementary pathways: neurohormonal stress (copeptin), early myocardial injury (H-FABP), inflammation and hypoxia (GDF-15), tissue hypoperfusion (lactate), and molecular regulation (circulating microRNAs). Readily available inflammatory indices derived from blood counts (NLR, PLR, LMR), red cell distribution width, and hs-CRP may further contribute within multimarker models, although specificity and validation remain limitations. Future directions include multimodal and omics-driven biomarker profiling integrated with advanced imaging to enable more precise, dynamic, and personalized PE care, from acute risk prediction to long-term follow-up and prevention of chronic thromboembolic complications. Full article

A challenge of studying mammalian cardiac embryogenesis is the limited ability to perform experimental manipulations in animal models. The avian embryo is widely accepted as a model for mammalian heart developmental studies. In this study, we establish the methodology and protocols for studying the Japanese quail (Coturnix japonica) heart at embryonic day 10 (HH38) using the FUJIFILM VisualSonics Vevo 3100 ultrasound system equipped with a MX550D small animal cardiology transducer. These protocols were designed to measure right ventricular wall thickness, pulmonary artery diameter, and the outflow velocities of the right ventricular outflow tract (RVOT) and the pulmonary artery (PA), thereby establishing baseline parameters of the normally developing quail morphology. Quail embryos are an ideal model for cardiovascular research due to their short incubation period (16–17 days), experimental accessibility, and strong similarities to mammalian heart development. These developmental similarities include, but are not limited to, looping, chamber septation, and the development of a true four-chamber heart. High-resolution imaging modalities, including ultrasound and optical coherence tomography, enable noninvasive, real-time visualization of cardiac morphology and function throughout development. Echocardiography allows for quantitative and qualitative assessments of myocardial structure and cardiac hemodynamics. The similarity to the mammalian heart, combined with rapid embryogenesis, makes quail embryos a valuable model for investigating congenital heart defects, genetic modifications, and fundamental cardiac developmental processes. In this study, we describe reproducible incubation protocols and baseline echocardiographic parameters used to evaluate morphological and physiological changes in the developing embryonic quail heart on embryonic day 10. Full article

Background/Objectives: Despite high recanalization rates associated with mechanical thrombectomy (MT), disability and death remain possible for many patients. Baseline stroke severity and reperfusion status predict outcomes; however, the influence of modifiable perioperative factors during general anesthesia (GA) remains unclear. We investigated actionable perioperative determinants of functional outcomes and 90-day mortality following MT under GA. Methods: We retrospectively analyzed 166 patients with acute ischemic stroke who underwent emergency MT with GA over 10 years (2014–2024). Poor functional outcomes were defined as a 90-day modified Rankin Scale score of 3–6, with all-cause 90-day mortality as the secondary endpoint. Independent predictors were identified using multivariable logistic regression, and discrimination was assessed using receiver operating characteristic analysis. Results: At 90 days, 56.6% of patients had poor functional outcomes, and mortality was 24.1%. Independent predictors of poor outcomes included preoperative hyperglycemia ≥ 140 mg/dL, vasopressor requirement, incomplete reperfusion, prolonged ventilator duration, and severe post-procedural neurological deficit. Optimal anesthetic induction dosing was strongly protective. Shorter groin puncture-to-recanalization time predicted better functional recovery. Mortality was associated with hyperglycemia, National Institutes of Health Stroke Scale ≥ 16, poor reperfusion, and prolonged ventilation. The models demonstrated excellent discrimination (area under the curve, 0.879 for poor outcomes; 0.923 for mortality). Perioperative physiological factors remained associated with outcomes independent of procedural success. Conclusions: Beyond technical success, perioperative physiological stability strongly influenced outcomes following MT under GA. Optimization of metabolic control, hemodynamic stability, procedural efficiency, and early ventilator liberation represents a clinically actionable strategy for improving neurological recovery and survival. Full article