Land of confusion: anaesthetic management during thrombectomy for acute ischaemic stroke

Stroke is a major global health issue, contributing to an age-standardised global death rate for cerebrovascular diseases of 86.5 per 100 000. For many years intravenous thrombolytic agents were the main treatment option for acute ischaemic strokes. In recent years, strong evidence has emerged that the use of intra-arterial thrombectomy in addition to standard care improves outcome after acute ischaemic strokes because of large vessel occlusions. The challenge for anaesthetists is to determine how they can assist the interventionists to optimise the treatment and improve clinical outcomes for patients undergoing intra-arterial thrombectomy. At present there are insufficient data upon which to guide anaesthetic management during intra-arterial thrombectomy because previous studies showed conflicting results and there is a lack of standardised reporting of relevant haemodynamic, respiratory, and anaesthetic parameters. We encourage anaesthetists working in thrombectomy capable centres to get actively involved in their neuro-interventional team. Their involvement can make an important contribution in investigating and implementing optimal management strategies for patients with acute ischaemic strokes requiring intra-arterial thrombectomy.