Anaesthesia care for mechanical thrombectomy in acute ischaemic stroke

Mechanical thrombectomy is the standard of care of large vessel occlusion anterior circulation acute ischaemic stroke. Clinical benefit until 24 hours after stroke onset are consequent to maintain functional independence and limit disability. These emergency procedures are difficult and occurred in frail patients with acute neurological dysfunction. Anaesthetic care is frequently necessary to optimise cerebral blood flow, prevent and treat organ dysfunction, limit patient movements, and prevent anxiety, pain, and discomfort. Anaesthetic care could be procedural sedation in spontaneous ventilation or general anaesthesia with tracheal intubation and mechanical ventilation. Each strategy has advantages and pitfalls. Recent data suggest equivalence between general anaesthesia, and procedural sedation provided blood pressure is maintained. After reperfusion, clinical management should prevent haemorrhagic complications in frequently hypertensive patients with potential coagulation disorders. Most severe posterior circulation acute ischaemic stroke, notably basilar artery occlusion, could also be treated with mechanical thrombectomy. In these cases, clinical status is often severe (coma...) with particular indication for general anaesthesia.