Neurointerventional procedures for unruptured intracranial aneurysms under procedural sedation and local anesthesia: a large-volume, single-center experience

Clinical article

Restricted access

Object

In this paper, the authors' goal was to report the outcome of patients with unruptured intracranial aneurysms undergoing endovascular treatment under conscious sedation (local anesthesia).

Methods

Between November 5, 2001, and February 5, 2009, the authors treated 340 patients with 358 unruptured aneurysms by using neurointerventional procedures at Millard Fillmore Gates Hospital (Buffalo, New York). The data were retrospectively reviewed for periprocedural safety and long-term follow-up.

Results

A total of 496 procedures were performed under local anesthesia. Of those, 370 procedures (74.6%) were completed successfully. In 82 procedures (16.5%), an associated medical or technical event occurred. Forty-four procedures (8.9%) were aborted. Rates of overall procedure-related morbidity and mortality were 1.2% (6 of 496) and 0.6% (3 of 496), respectively. The average hospital stay was 1.5 ± 2.5 days. Long-term follow-up was available in 261 (82.1%) of 318 patients whose procedures were performed with local anesthesia. Of those, 246 patients (94.3%) had a good outcome (modified Rankin Scale score ≤ 2), 6 patients (2.3%) had an unfavorable outcome, not related to the procedure, and 9 patients (3.4%) had a poor outcome (modified Rankin Scale score > 2) as a result of the intervention.

Conclusions

Interventional treatment under conscious sedation (local anesthesia) can be effectively performed in most patients with unruptured intracranial aneurysms and is associated with a short hospital stay and low morbidity and mortality.

Abbreviations used in this paper: CN = cranial nerve; ICU = intensive care unit; LOS = length of stay; mRS = modified Rankin Scale; TIA = transient ischemic attack.

Article Information

Address correspondence to: Christopher S. Ogilvy, M.D., Wang Ambulatory Care Center–ACC-745, Neurosurgical Service, Massachusetts General Hospital, Parkman Street, Boston, Massachusetts 02114. email: cogilvy@partners.org.

Please include this information when citing this paper: published online April 16, 2010; DOI: 10.3171/2010.3.JNS091384.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Graph showing yearly numbers of interventional procedures performed for unruptured intracranial aneurysms under local and general anesthesia (Anes).

  • View in gallery

    Graph showing yearly numbers of patients and aneurysms treated by interventional methods.

References

1

Brilstra EHRinkel GJvan der Graaf YSluzewski MGroen RJLo RT: Quality of life after treatment of unruptured intracranial aneurysms by neurosurgical clipping or by embolisation with coils. A prospective, observational study. Cerebrovasc Dis 17:44522004

2

Choi DSKim MCLee SKWillinsky RATerbrugge KG: Clinical and angiographic long-term follow-up of completely coiled intracranial aneurysms using endovascular technique. Clinical article. J Neurosurg 112:5755812010

3

Cloft HJKallmes DFKallmes MHGoldstein JHJensen MEDion JE: Prevalence of cerebral aneurysms in patients with fibromuscular dysplasia: a reassessment. J Neurosurg 88:4364401998

4

Gallas SDrouineau JGabrillargues JPasco ACognard CPierot L: Feasibility, procedural morbidity and mortality, and long-term follow-up of endovascular treatment of 321 unruptured aneurysms. AJNR Am J Neuroradiol 29:63682008

5

Gerlach RBeck JSetzer MVatter HBerkefeld JDu Mesnil de Rochemont R: Treatment related morbidity of unruptured intracranial aneurysms: results of a prospective single centre series with an interdisciplinary approach over a 6 year period (1999–2005). J Neurol Neurosurg Psychiatry 78:8648712007

6

Hauck EFWelch BGWhite JAReplogle REPurdy PDPride LG: Stent/coil treatment of very large and giant unruptured ophthalmic and cavernous aneurysms. Surg Neurol 71:19242009

7

Higashida RTLahue BJTorbey MTHopkins LNLeip EHanley DF: Treatment of unruptured intracranial aneurysms: a nationwide assessment of effectiveness. AJNR Am J Neuroradiol 28:1461512007

8

Im SHHan MHKwon OKKwon BJKim SHKim JE: Endovascular coil embolization of 435 small asymptomatic unruptured intracranial aneurysms: procedural morbidity and patient outcome. AJNR Am J Neuroradiol 30:79842009

9

Johnston SCDudley RAGress DROno L: Surgical and endovascular treatment of unruptured cerebral aneurysms at university hospitals. Neurology 52:179918051999

10

Kang HSHan MHLee THShin YSRoh HGKwon OK: Embolization of intracranial aneurysms with hydrogelcoated coils: result of a Korean multicenter trial. Neurosurgery 61:51592007

11

Koebbe CJVeznedaroglu EJabbour PRosenwasser RH: Endovascular management of intracranial aneurysms: current experience and future advances. Neurosurgery 59:5 Suppl 3S93S1132006

12

Lee TBaytion MSciacca RMohr JPPile-Spellman J: Aggregate analysis of the literature for unruptured intracranial aneurysm treatment. AJNR Am J Neuroradiol 26:190219082005

13

Meisel HJMansmann UAlvarez HRodesch GBrock MLasjaunias P: Cerebral arteriovenous malformations and associated aneurysms: analysis of 305 cases from a series of 662 patients. Neurosurgery 46:7938022000

14

Mocco JSnyder KVAlbuquerque FCBendok BRAlan SBCarpenter JS: Treatment of intracranial aneurysms with the Enterprise stent: a multicenter registry. Clinical article. J Neurosurg 110:35392009

15

Nguyen TNHoh BLAmin-Hanjani SPryor JCOgilvy CS: Comparison of ruptured vs unruptured aneurysms in recanalization after coil embolization. Surg Neurol 68:19232007

16

Pandey ASKoebbe CRosenwasser RHVeznedaroglu E: Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms: review of a 10-year experience. Neurosurgery 60:6266372007

17

Park HKHorowitz MJungreis CGenevro JKoebbe CLevy E: Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol 26:5065142005

18

Park HKHorowitz MJungreis CKassam AKoebbe CGenevro J: Endovascular treatment of paraclinoid aneurysms: experience with 73 patients. Neurosurgery 53:14242003

19

Park SHLee CYYim MB: The merits of endovascular coil surgery for patients with unruptured intracranial aneurysms. J Korean Neurosurg Soc 43:2702742008

20

Piepgras DGBrown RD Jr: Management of unruptured intracranial aneurysms: perspectives on endosaccular coiling and persistent uncertainties. Stroke 39:7437442008

21

Pierot LSpelle LVitry F: ATENA: the first prospective, multicentric evaluation of the endovascular treatment of unruptured intracranial aneurysms. J Neuroradiol 35:67702008

22

Pierot LSpelle LVitry F: Immediate clinical outcome of patients harboring unruptured intracranial aneurysms treated by endovascular approach: results of the ATENA study. Stroke 39:249725042008

23

Piotin MSpelle LMounayer CLoureiros CGhorbani AMoret J: Intracranial aneurysms coiling with matrix: immediate results in 152 patients and midterm anatomic follow-up from 115 patients. Stroke 40:3213232009

24

Piske RLKanashiro LHPaschoal EAgner CLima SSAguiar PH: Evaluation of Onyx HD-500 embolic system in the treatment of 84 wide-neck intracranial aneurysms. Neurosurgery 64:E865E8752009

25

Quadros RSGallas SNoudel RRousseaux PPierot L: Endovascular treatment of middle cerebral artery aneurysms as first option: a single center experience of 92 aneurysms. AJNR Am J Neuroradiol 28:156715722007

26

Qureshi AISuri MFKhan JKim SHFessler RDRinger AJ: Endovascular treatment of intracranial aneurysms by using Guglielmi detachable coils in awake patients: safety and feasibility. J Neurosurg 94:8808852001

27

Rordorf GBellon RJBudzik RE JrFarkas JReinking GFPergolizzi RS: Silent thromboembolic events associated with the treatment of unruptured cerebral aneurysms by use of Guglielmi detachable coils: prospective study applying diffusion-weighted imaging. AJNR Am J Neuroradiol 22:5102001

28

Suzuki STateshima SJahan RDuckwiler GRMurayama YGonzalez NR: Endovascular treatment of middle cerebral artery aneurysms with detachable coils: angiographic and clinical outcomes in 115 consecutive patients. Neurosurgery 64:8768892009

29

Tummala RPChu RMMadison MTMyers MTubman DNussbaum ES: Outcomes after aneurysm rupture during endovascular coil embolization. Neurosurgery 49:105910672001

30

Vallée JNPierot LMont'alverne FTurjman FBonafé ABracard S: Unruptured intracranial aneurysms treated by three-dimensional coil embolization: evaluation of the postoperative aneurysm occlusion volume. Neuroradiology 47:4384452005

31

van Rooij WJSluzewski M: Procedural morbidity and mortality of elective coil treatment of unruptured intracranial aneurysms. AJNR Am J Neuroradiol 27:167816802006

32

White PMLewis SCNahser HSellar RJGoddard TGholkar A: HydroCoil Endovascular Aneurysm Occlusion and Packing Study (HELPS trial): procedural safety and operator-assessed efficacy results. AJNR Am J Neuroradiol 29:2172232008

33

Wiebers DOWhisnant JPHuston J IIIMeissner IBrown RD JrPiepgras DG: Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:1031102003

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 52 52 21
Full Text Views 134 134 21
PDF Downloads 92 92 13
EPUB Downloads 0 0 0

PubMed

Google Scholar