• Ugan Reddy and Martin Smith.
• Department of Neuroanesthesia and Neurocritical Care, The National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK.
• Curr Opin Anaesthesiol. 2012 Aug 1;25(4):486-92.

Purpose Of ReviewThe article reviews the treatment options for cerebrovascular atherosclerosis and highlights the challenges of anesthesia in this complex group of patients.Recent FindingsPercutaneous 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.SummaryThe 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.

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