Feasibility, Safety, and Periprocedural Complications Associated with Endovascular Treatment of Ruptured Intracranial Aneurysms according to the Depth of Anesthesia

Abstract

BACKGROUND AND PURPOSE: The aim of the present study was to report the feasibility, safety, and periprocedural complications associated with EVT of ruptured intracranial aneurysms according to the depth of anesthesia. In most centers, endovascular treatment of intracranial aneurysm is performed under general anesthesia. MATERIALS AND METHODS: Between March 2011 and December 2016, a total of 183 consecutive patients with 183 aneurysms were treated endovascularly at the authors' center. The data about the depth of anesthesia (local anesthesia, conscious sedation, deep sedation, and general anesthesia), procedural details, and clinical and radiologic outcomes were reviewed. RESULTS: A total of 183 consecutive patients with 183 aneurysms (mean age, 60.2 14.8 years; 54 men and 129 women) were successfully treated. Of these, 70 (38.3%) patients underwent endovascular treatment under local anesthesia, 33 (18.0%) patients underwent endovascular treatment under conscious sedation, 78 (42.6%) patients underwent endovascular treatment under deep sedation, and only 2 (1.1%) patients underwent endovascular treatment under general anesthesia. For patients who presented with Hunt and Hess grades 1, 2, 3, 4, and 5, 75%, 59.6%, 59.1%, 53.3%, and 35.3% were treated under local anesthesia or conscious sedation, respectively. The procedure-related complication rates amounted to 8.7% (16/183, with 11 thromboembolic complications and 5 intraprocedural ruptures) overall, and 7.7% (14/183) of complications were symptomatic events. In the patients with good clinical grade (Hunt and Hess 1 or 2), the procedure-related complication rate was 4.1% (4/97), and all complications were symptomatic events under local anesthesia or conscious sedation. CONCLUSIONS: In the authors' experience, local anesthesia or conscious sedation seemed safe and feasible for the patients with good clinical grade SAH.