J Neurocrit Care.  2018 Dec;11(2):93-101. 10.18700/jnc.180059.

Feasibility, Safety, and Follow-up Angiographic Results of Endovascular Treatment for Non-Selected Ruptured Intracranial Aneurysms Under Local Anesthesia with Conscious Sedation

• Kang J
• Kang CH
• Roh J
• Yeom JA
• Shim DH
• Kim YS
• Lee SW
• Kim YS
• Park KH
• Kim CH
• Kim SK
• Choi NC
• Kwon OY
• Kang H
• Baik SK

• KMID: 2434835
• DOI: http://doi.org/10.18700/jnc.180059

Abstract

BACKGROUND
At most centers, general anesthesia (GA) has been preferred for endovascular treatment (EVT) of ruptured intracranial aneurysms (RIAs). In this study, we analyzed procedural results, clinical outcomes, and follow-up angiographic findings for patients undergoing EVT for RIA under local anesthesia (LA) with conscious sedation (CS).
METHODS
We retrospectively evaluated 308 consecutive patients who underwent EVT for RIAs at a single institution between June 2009 and February 2017. EVT under LA with CS was considered for all patients with aneurysmal subarachnoid hemorrhage, regardless of Hunt and Hess (HH) scale score.
RESULTS
EVT was performed for 320 aneurysms in 308 patients with subarachnoid hemorrhages. The mean patient age was 55.5±12.6 years. Moderate (III) and poor (IV, V) HH grades were observed in 75 (24.4%) and 77 patients (25%), respectively. Complete occlusion immediately after EVT was achieved for 270 (84.4%) of 320 aneurysms. Thromboembolic complications and intraprocedural ruptures occurred in 25 (7.8%) and 14 cases (4.3%), respectively. The morbidity rate at discharge (as defined by a modified Rankin scale score of 3 or greater) was 27.3% (84/308), while the mortality rate was 11.7% (36/308). Follow-up angiographic results were available for 210 (68.1%) of 308 patients. Recanalization was observed in 64 (29.3%) of 218 aneurysms in 210 patients.
CONCLUSION
Based on our experience, EVT for RIAs under LA with CS was feasible, regardless of the clinical grade of the subarachnoid hemorrhage. Complication rates and follow-up angiographic results were also comparable to those observed when GA was used to perform the procedure.

Keyword

Intracranial aneurysms; Endovascular procedures; Anesthesia, Local

MeSH Terms

Anesthesia, General
Anesthesia, Local*
Aneurysm
Conscious Sedation*
Endovascular Procedures
Follow-Up Studies*
Humans
Intracranial Aneurysm*
Mortality
Retrospective Studies
Rupture
Subarachnoid Hemorrhage

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