Background and Purpose— In retrospective studies, patients receiving general anesthesia for endovascular treatment for acute ischemic stroke have worse neurological outcome compared with patients receiving conscious sedation. It has been suggested that this is caused by general anesthesia–associated hypotension. We investigated the effect of intraprocedural hypotension on neurological outcome. Methods— One hundred eight patients with acute ischemic stroke, who underwent endovascular treatment in general anesthesia between 2007 and 2012, were included. Analyzed predictors of neurological outcome were age, sex, comorbidities, baseline National Institutes of Health Stroke Scale, intraprocedural relative changes in mean arterial blood pressure from baseline, blood glucose, modified Thrombolysis in Cerebral Infarction score, and elapsed time from stroke to computed tomography, groin puncture, and recanalization/end of procedure. Results— A fall in mean arterial blood pressure of >40% was an independent predictor for poor neurological outcome ( P =0.032), as were higher admission National Institutes of Health Stroke Scale score ( P =0.008) and lack of recanalization ( P =0.003). Conclusions— Profound intraprocedural hypotension is an independent predictor for poor neurological outcome in patients with acute ischemic stroke undergoing endovascular therapy in general anesthesia.