<![CDATA[Background: Acute ischemic stroke (AIS) caused by cerebral vascular occlusion requires rapid reperfusion to prevent irreversible neuronal damage. Mechanical thrombectomy is currently the standard of care alongside intravenous thrombolysis for appropriately selected patients with AIS, as supported by randomized clinical trials and stroke guidelines. However, despite its clinical benefits, thrombectomy presents significant anesthesiological challenges, particularly regarding the prevention of post-procedural neurological complications, such as reperfusion syndrome.Case: A 64-year-old man with heart disease and diabetes mellitus underwent mechanical thrombectomy for AIS under general anesthesia with close monitoring of blood pressure, ventilation, and hemodynamic status. Following successful recanalization, the patient developed persistent aphasia with suspected cerebral edema. Reperfusion syndrome was considered based on the temporal relationship between restored cerebral blood flow and neurological deterioration, while other possible causes were evaluated clinically.Discussion: Reperfusion syndrome is a recognized but uncommon complication after successful cerebral recanalization. Intensive care unit (ICU) management included close neurological observation, hemodynamic stabilization, blood pressure control, optimization of oxygenation and ventilation, targeted temperature management at 35–36°C for 24 hours, and antioxidant therapy with N-acetylcysteine 200 mg every 8 hours. These interventions were applied as individualized supportive strategies rather than established standard treatment.Conclusion: This case highlights the importance of individualized anesthetic management, strict physiological control, early recognition of post-thrombectomy neurological deterioration, and multidisciplinary ICU care to minimize secondary brain injury. ]]>
