- Anesthesiologists play a vital role in the management of intracranial aneurysms (IAs). The goal of endovascular repair of IAs is the occlusion of the proximal feeding arteries or obliteration of the aneurismal sac. Destruction of the sac while sparing the parent artery can be difficult, and can lead to distal embolism and rupture. The anesthesiologist must always be prepared for potential complications. This article provides a brief description of the principles of anesthesia for endovascular repair of intracranial aneurysms, as well as the relevant epidemiological, pathophysiological, diagnostic and therapeutic points. The goal of anesthesia in endovascular IA repair is to maintain an adequate hemodynamic profile and avoid decreases in cerebral perfusion pressure. Cerebral ischemia, increased intracranial pressure (ICP), and hemodynamic instability are intraoperative concerns.