Background　Acute ischemic stroke (AIS) is the leading cause of mortality in our country. With the development of intervention devices and technology, endovascular treatment (EVT) significantly increases the rate of recanalization of occluded blood vessels, prolongs the critical time window for treatment, and shows a good application prospect. But it is always arguable about the best anesthesia strategy to perform EVT.　Objective　To review the current strategiesi for anesthesia management in the AIS patients undergoing EVT.　Content　The apparent benefits of EVT to AIS, depend on the advances in the techniques and devices for this treatment. Additionally, anesthetic management is also a major factor to determine the efficacy of EVT in AIS treatment. General anesthesia can immobilize patients, confer excellent analgesia, and provide optimal ventilation. But, it may perturb the stability of hemodynamics, delay recanalization of occluded blood vessels, and promote the risk of inhalation of secretion and pulmonary infection. Local anesthesia can fulfill satisfying analgesic effects while retains wakefulness and stable hemodynamics, thus facilitates real-time functional monitoring of the nervous system. However, the body movement and agitation following inadequate analgesia sometimes perturb ventilation through the airway and compromise the therapeutic benefits of EVT. This article reviews efforts that have been made to improve the efficacy of EVT in AIS treatment under either general or local anesthesia.　Trend　Protection of brain ischemic penumbra is a major strategy for AIS treatment. The choice of general or local anesthesia should be personalized to take patients risks and requirements into consideration. Further prospective randomized controlled studies are demanded to evaluate the influence of general and local anesthesia on the function of the nervous system in AIS patients undergoing EVT.