Provocative test with propofol: experience in patients with cerebral arteriovenous malformations who underwent neuroendovascular procedures.
OBJECTIVE
Provocative testing before AVM embolization has been shown to be a predictor of a successful endovascular treatment without neurologic deficits. Propofol has been used previously as an alternative agent in Wada testing with adequate results. The purpose of this study was to show our experience with the use of propofol as a safe and effective alternative to barbiturate provocative testing in AVM embolization procedures.


METHODS
A series of 20 patients, undergoing 38 embolization sessions, was treated for cerebral AVMs between November 2007 and February 2009 by endovascular methods. All patients were treated under conscious sedation. Pre-embolization neurologic assessment was performed with provocative testing by using propofol at 7-mg doses by an intra-arterial route after microcathether placement in or near the AVM nidus.


RESULTS
Among these 20 patients, 3 developed transient neurologic deficits after provocative testing, precluding initial or further embolization. One of the patients passing the provocative test developed slight paresis as a result of embolization with n-BCA, resulting in a PPV of 97%.


CONCLUSIONS
Propofol use during provocative testing in AVM embolization procedures represents an effective alternative to barbiturate testing and can have a positive impact in improving safety under sedation.
Feliciano
C E
CE
Department of Surgery, Section of Neurological Surgery, Neuroendovascular Surgery Program, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico. caleb.feliciano@upr.edu
de León-Berra
R
R
Hernández-Gaitán
M S
MS
Torres
H M
HM
Creagh
O
O
Rodríguez-Mercado
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D002648:Child; D003943:Diagnostic Techniques, Neurological; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007269:Injections, Intra-Arterial; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015742:Propofol / Q000008:administration & dosage; D055815:Young Adult
D006993:Hypnotics and Sedatives; D015742:Propofol