title: Interventional neuroradiology cases with intraprocedural clots: initial experience.
abstract: OBJECTIVE
  Intraprocedural clot formation is rare but potentially serious complication of interventional neuroradiology procedures. We investigate if intraoperative monitoring (IOM) has utility to detect such clots. Intraprocedural clot formation is a rare but potentially serious complication of interventional neuroradiology procedures. Intraoperative monitoring detected nearly half of the included cases first. All of the included patients without improvement of the IOM changes were discharged home at best severely disabled.
  
  
  METHODS
  The study included patients with thromboembolic events during interventional neuroradiology cases at Barrow Neurologic Institute from 2006 to 2010, with prespecified outcomes. Electroneurodiagnostic recordings were reviewed.
  
  
  RESULTS
  Twelve patients were included in this study. All showed changes in their IOM. Five showed a change in IOM recording before a change was seen on the angiogram. Two returned to baseline, four improved but not to baseline, and six did not improve at all. All six patients without IOM improvement were discharged at best severely disabled. Ten of the 12 patients with clots had a subarachnoid hemorrhage before treatment.
  
  
  CONCLUSIONS
  Intraoperative monitoring recording may be a valuable tool in monitoring patients during endovascular treatment to identify intraprocedural thromboembolic events. Intraoperative monitoring may correlate with poor outcomes when the changed responses do not improve. These data might be important when determining how aggressive to be in treating intraprocedural clots. Electroneurodiagnostic seems to be particularly warranted in patients with subarachnoid hemorrhage before treatment. A larger study is needed to validate these findings.
authors.affiliation: *Geisinger Health System, Danville, PA; and the †Barrow Neurological Institute, Phoenix, AZ.
authors.forename: David S
authors.initials: DS
authors.lastname: Gloss
authors.forename: Brian W
authors.initials: BW
authors.lastname: Alkire
mesh_terms: D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007431:Intraoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016343:Monitoring, Intraoperative / Q000379:methods*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011859:Radiography