title: Anaesthesia for neuroradiology: thrombectomy: 'one small step for man, one giant leap for anaesthesia'.
abstract: OBJECTIVE
  Endovascular management of acute thrombotic strokes is a new management technique. Anaesthesia will play a key role in the management of these patients. To date there is no established method of managing these patients from an anaesthetic perspective.
  
  
  RESULTS
  In 2015, five landmark studies popularized intra-arterial clot retrieval for ischaemic strokes. Since then there have been a number of small studies investigating the best anaesthetic technique, taking into account patient, technical, and clinical factors. This review summarizes these studies and discusses the different anaesthetic options, with their relative merits and pitfalls.
  
  
  CONCLUSIONS
  There is a paucity of robust evidence for the best anaesthetic practice in this cohort of patients. Airway protection seems to be an issue in 2.5% of cases. Timing of the procedure is vital, and any delay may be detrimental to neurological outcome. In a survey of neurointerventionalists, the main concern they expressed was the potential delay to revascularization posed by anaesthesia. Patients complain of pain during mechanical clot retrieval if awake. The overall consensus seems to be favouring conscious sedation over general anaesthesia in the acute setting.
authors.affiliation: aDepartment of Neuro Intensive Care bDepartment of Anaesthesiology, Queen's Hospital, BHR NHS Trust, Romford, Essex, UK.
authors.forename: Dhuleep S
authors.initials: DS
authors.lastname: Wijayatilake
authors.forename: Gamunu
authors.initials: G
authors.lastname: Ratnayake
authors.forename: Dassen
authors.initials: D
authors.lastname: Ragavan
mesh_terms: D000758:Anesthesia / Q000379:methods*; D000777:Anesthetics / Q000008:administration & dosage / Q000009:adverse effects; D001921:Brain / Q000098:blood supply; D057785:Catheters; D002548:Cerebral Revascularization / Q000295:instrumentation / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D002986:Clinical Trials as Topic; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D015276:Health Care Rationing; D006801:Humans; D064926:Neurophysiological Monitoring; D015642:Radiology, Interventional / Q000295:instrumentation / Q000379:methods*; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors
chemical_list: D000777:Anesthetics