Anesthetic Considerations for Interventional Radiology in Acute Ischemic Cerebral Stroke (AIS)

Acute ischemic stroke (AIS) is the leading cause of adult disability and the third leading cause of death. Sudden loss of focal brain function is the core feature of the onset of AIS and, until recently, it was considered to be untreatable. Major advances in endovascular therapy in the past 10 to 15 years have now made treatment a reality, with a potential for remarkable recovery. Timely restoration of cerebral blood flow using reperfusion therapy is presently the most effective maneuver for salvaging ischemic brain tissue that is not already infarcted. (1,2) AIS and transient ischemic attacks are caused by cardiac embolism, cervical atherosclerosis with thrombosis or artery-to-artery embolism, intracranial atherosclerosis leading to thrombosis or hypoperfusion, perforator occlusion due to lipohyalinosis, arteriosclerosis, or embolism, and spontaneous or traumatic arterial dissection, vasculitis and venous thrombosis, among others. Numerous factors affect neurological outcome and the main risk is that of intracerebral hemorrhage (ICH) - the most feared and devastating complication associated with all treatments for ischemic stroke. The risk of ICH is the single greatest limiting factor for AIS recanalization therapy, because there is no effective treatment for ICH and, when it complicates AIS revascularization treatment, mortality is high. Stroke specialists, therefore, need to have a thorough understanding of all clinical, anatomical, pathological, and radiological aspects of AIS and the spectrum of ICH to make reasonable decisions regarding intra-arterial therapy (IAT) in every patient.