In the last 10 years interventional neuroradiology has become established especially in the endovascular treatment of aneurysms as the preferred treatment according to level 1 evidence and more recently in the treatment of acute ischemic stroke. These interventions are performed as routine procedures in an increasing number of centers. This, however, necessitates that anesthesiologists and neuroradiologists become increasingly more familiar with the complementary expectations and potential pitfalls in working together to maximise efficiency and patient safety. As a further challenge there are different aspects to be considered in elective procedures and emergency procedures where time is brain. This article highlights these aspects for the two most common procedures: aneurysm treatment and multimodal recanalization treatment for acute ischemic stroke.