[Treatment of intracranial aneurysm in interventional neuroradiology. What problems for the anesthetist?].
OBJECTIVE
To outline the most occurring complications during endovascular treatment of intracranial aneurysms.


METHODS
Retrospective review of thirty-four patients treated from October 1994 to February 1996 with the placement of mechanically detachable microcoils inside the aneurysmal sac.


METHODS
Interventional neuroradiology suite equipped for anesthetic care.


METHODS
Thirty-four patients with ruptured (88%) or unruptured (12%) intracranial aneurysm submitted to elective (38%) or emergency (62%) endovascular treatment. Aneurysms were located in the anterior circulation in twenty-six patients (76%) and in the posterior circulation in eight patients (24%).


METHODS
A microcatheter was introduced into the arterial cerebral circulation to deliver tungsten microcoils to aneurysmal sac. The transfemoral approach was used in most cases. All patients were treated under general anesthesia with tracheal intubation, conventional mechanical ventilation and neuromuscular blockade. The procedure was performed under anticoagulation with heparin and intravenous nimodipine administration.


METHODS
Neurological assessment was performed at the time of treatment (H&H 1) and six hours after the end of intervention (H&H 2) using Hunt and Hess classification system. The outcome was scored at four weeks following treatment using Glasgow Outcome Scale (GOS).


RESULTS
Twenty-two (65%) interventions were successful. Attempted embolization failed in twelve (35%) patients due to intraoperative complications (17.6%) or technical difficulties (17.6%). Failures were more frequently determinated by vasospasm and haemorrhage.


CONCLUSIONS
The time of intervention, the use of heparin and the patient medical conditions need to be considered in preventing the complications of endovascular treatment.
Barbagli
R
R
Servizio di Anestesia e Rianimazione CTO, Azienda Ospedaliera Careggi, Firenze.
Faggi
S
S
Doni
L
L
Marchini
O
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D017211:Treatment Failure; D016896:Treatment Outcome
Il trattamento degli aneurismi intracranici in neuroradiologia interventistica. Quali i problemi per l'anestesista?