Procedural / Technique

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Mechanical Thrombectomy for Acute Ischemic Stroke

Anesthetic management of endovascular clot extraction for large-vessel occlusion stroke

Mechanical thrombectomy is endovascular clot extraction indicated for major acute ischemic stroke from large-vessel (typically MCA) occlusion within 6 hours of symptom onset (up to 24 h in selected patients per DAWN/DEFUSE-3), especially when IV tPA is contraindicated; keep SBP 140-180 mmHg without delaying reperfusion.

If you forget

Headline: Time is brain — never delay reperfusion for anesthesia setup

Board trap

Delaying induction to obtain an arterial line before thrombectomy is wrong — invasive monitoring must NOT postpone reperfusion, and the femoral sheath placed by the neurointerventionist serves as dual arterial access.

Key numbers

SBP target 140-180 mmHg during endovascular procedure
Endovascular window: ≤6 hours from symptom onset for MCA occlusion
IV tPA window: ≤3 h firm; ≤4.5 h conditional
Pre-tPA BP ceiling: SBP ≤185 mmHg, DBP ≤110 mmHg
Oxygenation: SpO2 >94% (or >92%); PaO2 >60 mmHg; normocapnia

Reviewed Sep 24, 2026 for clinical accuracy by BoardsBridge Editorial Process

Uri Rozen, MD — Licensed Physician, Israel

Source guidelines: SNACC Neuroanesthetic Emergencies 2020 · SNACC Neuroanesthetic Emergencies 2020 · SNACC Neuroanesthetic Emergencies 2020 · SNACC Neuroanesthetic Emergencies 2020

Re-review cadence: 12 months from reviewed date.

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Card ID: mechanical-thrombectomy · Path: aba.neuro.neurointerventional.mechanical-thrombectomy