Anesthetic management of endovascular procedures for cerebrovascular atherosclerosis.

PURPOSE OF REVIEW: The article reviews the treatment options for cerebrovascular atherosclerosis and highlights the challenges of anesthesia in this complex group of patients.

RECENT FINDINGS: Percutaneous transluminal angioplasty and stenting is a treatment option for cerebrovascular atherosclerosis in patients at high risk of stroke despite maximal medical therapy and control of risk factors. The majority of carotid lesions are treated using regional anesthesia, but general anesthesia is currently the technique of choice for intracranial lesions because of the length of the procedures and the need for immobility. There is no evidence to guide optimal anesthetic management in this group of patients in whom significant comorbidities are common. The risks of myocardial ischemia, cardiovascular instability and cerebral ischemia and hyperperfusion are high, and anesthesia management should be directed towards their prevention, recognition and treatment.

SUMMARY: The anesthetist plays a key role in the endovascular management of patients with cerebrovascular atherosclerosis. Optimization of comorbidities, meticulous control of systemic physiologic variables and aggressive management of complications contribute to enhanced patient outcome.