Acute ischemic stroke caused by the occlusion of large brain vessels can be treated effectively by mechanical thrombectomy, as proved by recent strong and consistent evidence from high-quality randomized trials. This new era of endovascular stroke treatment, however, poses particular challenges that go far beyond the so far gold standard of intravenous thrombolysis alone. Because these stroke patients usually present with severe neurologic deficits, may be unstable from cardiac or pulmonary instability, have to endure an invasive intervention of sometimes long duration, may suffer complications and require close postinterventional follow-up, they often demand intensive care measures. These involve monitoring, blood pressure adjustment, sedation and analgesia, possibly intubation and ventilation, often postprocedural transfer to an intensive care unit, and treatment of potential complications. Many of these aspects, however, have not been sufficiently clarified so far. In this review, the author aims to critically appraise the intensive care management elements of peri-interventional stroke management based on the current evidence, pathophysiologic considerations, and personal experience.
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