The choice of anesthetic technique varies depend- ing on the institution, with the most common techniques being conscious sedation and general anesthesia.202 204 There have been no studies comparing these 2 techniques. One of the main goals of the anesthetic technique is keeping the patient motionless to optimize the quality of the images used to perform the endovascular procedure; hence, general anes- thesia with endotracheal intubation is often preferred for these procedures. Intraprocedural aneurysm rupture during endovascular treatment presents a major challenge unlike that encountered with open craniotomy. There may be a sudden and massive rise in blood pressure with or without bradycardia attributable to an elevation in intracranial pressure. Hyperventilation and osmotic diuresis may be required to control the intracranial hypertension. Aggressive treatment of surges in blood pres- sure may induce ischemia; therefore, antihypertensive ther- apy should be reserved for patients with extreme elevations in blood pressure. Endovascular procedures differ from open procedures in that anticoagulation with heparin is frequently administered during the embolization of aneurysms. Patients who have undergone anticoagulation require rapid reversal with prota- mine if intraprocedural aneurysm rupture occurs. With the increasing use of intravascular stents, the administration of antiplatelet agents (aspirin, clopidogrel, and glycoprotein IIb/IIIa receptor antagonists) during these procedures has become more common. In case of intraprocedural rupture, rapid reversal of antiplatelet activity can be attempted by platelet transfusion. Anesthetic Management During Surgical and Endovascular Treatment: Recommendations 1. Minimization of the degree and duration of intraop- erative hypotension during aneurysm surgery is probably indicated (Class IIa; Level of Evidence B). 2. There are insufficient data on pharmacological strate- gies and induced hypertension during temporary ves- sel occlusion to make specific recommendations, but there are instances when their use may be considered reasonable (Class IIb; Level of Evidence C). 3. 