Neurointerventional radiology (NIR) for the diagnosis and treatment of neurological conditions has undergone significant advances. The scope of disease amenable to endovascular therapy continues to expand, with pathology previously requiring open surgery, now managed in the NIR suite. Anaesthetists will become more involved in providing care for these patients, in particular those with acute ischaemic stroke since incidence is increasing, and access to mechanical thrombectomy services is a priority in the NHS Long Term Plan. NIR procedures can be complex and lengthy, and close liaison between the radiology, neurosurgical, stroke and anaesthesia teams is vital. To underpin this, a good understanding of the environment, procedures and their physiological effects as well as the anaesthetic implications is also required. Close monitoring for complications both during and following the procedure is necessary to promptly recognize and treat these, either via further radiological treatment or by surgery.