Objective To investigate the current status of anesthetic management and patient safety in acute ischemic stroke (AIS) patients undergoing endovascular therapy (EVT) in China. Methods A self‑designed Questionnaire Star applet electronic questionnaire was applied through a number of society and association channels from October 23, 2023 to November 23, 2023. The questionnaire covered some of the secondary and above medical health care institutions with the national EVT qualification certification, within 31 provinces, municipalities directly under the central government and autonomous regions of Chinese mainland. The participants of the questionnaire survey were required to scan the QR code to enter the Questionnaire Star applet, and each WeChat account was limited to one questionnaire submission. The core indicators of the questionnaire included: ① introduction of medical institution, including the region where the institution is located, the level of accreditation of the hospital, and the number of cases of EVT for patients with AIS completed during the year/the number of valid questionnaires per year and the percentage of such cases; ② the degree of participation of anesthesiologists during EVT for AIS patients, involving the handover process of the patients (emergency room‑emergency intervention room handover), the structure of the treatment team (composition of anesthesiologists in the treatment team), preoperative anesthesia assessment for EVT, communication between anesthesiologists and interventionalists during EVT, and postoperative patient transfer; ③ relevant information indexes and attention of anesthesia management during EVT, involving the maintenance of circulation, respiration and blood glucose, corresponding drug intervention strategies, the selection and management of anesthesia modes and the attention towards key information in the perioperative period; ④ quality control of anesthesia management. The following methods were applied to determine the validity of the questionnaire: the completion time was more than 5 min; when multiple questionnaires were completed within the same unit, the principle of the law of large numbers was applied; during data analysis, if the number of feedbacks for a certain option was <1% of the number of valid questionnaires, the questionnaire samples containing that option would be excluded. Results A total of 1 096 valid questionnaires (hereinafter referred to as "questionnaires") were collected from 748 hospitals with the national EVT accreditation, of which 146 (about 13.3%) were from secondary medical institutions and 950 (about 86.7%) were from tertiary medical institutions. The proportion of the questionnaire completely in hospitals with 51 to 100 cases during the year was about 22.1%, which was the highest. The proportion of the questionnaires completely in hospitals with 401 to 500 cases during the year was about 2.2%, which was the lowest. During transfer from the emergency room to the emergency intervention unit, 1 012 questionnaires (about 92.3%) showed that anesthesiologists were involved in the handover process; 984 questionnaires (about 89.8%) showed at least one anesthesiologist was included in the composition of the treatment team; 377 questionnaires (about 34.4%) showed that anesthesia assessment was not performed before EVT; 72 questionnaires (about 6.6%) showed that there was almost no information exchange between anesthesiologists and neurointerventionists during EVT; and 101 questionnaires (about 9.2%) showed that anesthesiologists had hardly involved in postoperative patient transfer. During treatment, about 67.1% of respondents set the target value for intraoperative systolic pressure management at 140−180 mmHg (1 mmHg=0.133 kPa), about 87.2% of respondents maintained the arterial partial pressure of carbon dioxide at 30−40 mmHg in AIS patients during EVT, the proportion of respondents who maintained the concentration of inhaled oxygen at >40% was about 84.6%, only about 10.5% of respondents did not focus on perioperative glucose management; approximately 56.0% patients returned to intensive care unit with endotracheal tube after EVT and about 45.4% patients were followed up after EVT. During this questionnaire survey, 689 questionnaires showed a preference for fixed procedure anesthesia and 407 for context‑adapted anesthesia; in terms of anesthesia type and preference, about 82.9% of respondents paid more attention to anesthesia management in patients with AIS during EVT; the key perioperative messages with the highest level of respondents' attention were the patient's circulatory message, state of consciousness and respiratory messages (top 3). About 87.5% of respondents (959 questionnaires) showed that domestic and foreign guidelines would be followed during the anesthesia management of EVT; up to 77% of the questionnaires (844) indicated severe adverse events during the perioperative period, including cardiac arrest, guidewire penetration of the blood vessels, and anaphylactic shock. However, only about 40.7% of the questionnaires (446) showed that anesthesiology departments carried out a report on quality control of neurointerventional anesthesia for EVT in patients with AIS. Conclusions Anesthesiologist is an essential part of the team performing EVT in AIS patients. Treatment team is more focused on perioperative anesthesia management and control of related risk factors. Anesthesiology departments need to improve their work in anesthesia quality control.