Feasibility, Safety, and Periprocedural Complications of Pipeline Embolization for Intracranial Aneurysm Treatment Under Conscious Sedation: University at Buffalo Neurosurgery Experience.
BACKGROUND
Endovascular Pipeline Embolization Device (PED) placement for intracranial aneurysms is performed under general anesthesia at most centers because of perceived improved image quality and patient safety.


OBJECTIVE
To report the feasibility, safety, and outcomes associated with the use of the PED for intracranial aneurysms performed in awake patients after the administration of conscious sedation (CS) and a local anesthetic.


METHODS
Between March 2012 and September 2014, 130 patients with 139 intracranial aneurysms (8 ruptured) were treated with the PED under CS at our institution. Procedure details and time (including duration, radiation exposure, and fluoroscopy) and procedure-related complications were retrospectively reviewed.


RESULTS
A total of 155 PED deployment procedures were performed under CS. Treatment was successfully completed in all cases. Anesthesia was converted from CS to general anesthesia during 5 procedures. Mean interval from patient entry at the endovascular suite to procedure initiation was 18 minutes (range, 5 minutes-1 hour 10 minutes). Mean procedure length was 1 hour 25 minutes (range, 30 minutes-3 hours 51 minutes). Mean ± SD values for fluoroscopy time and radiation exposure were 36.17 ± 18.4 minutes and 1367 ± 897 mGy, respectively. The mean amount of contrast material administered was 211.37 ± 83.5 mL. Permanent neurological complications were seen in 4 patients (3%).


CONCLUSIONS
In our experience, CS for PED placement for intracranial aneurysm treatment is feasible and safe. Procedure and fluoroscopy times and amount of radiation exposure are similar to or less than described in reports of PED placement under general anesthesia. CS allows direct neurological evaluation and earlier detection of and response to intraprocedural complications.
Departments of *Neurosurgery, ¶Radiology, and §Neurology, School of Medicine and Biomedical Sciences; ‡Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, and ‖Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York; #Jacobs Institute, Buffalo, New York.
Leonardo
L
Rangel-Castilla
Marshall C
MC
Cress
Stephan A
SA
Munich
Ashish
A
Sonig
Chandan
C
Krishna
Eugene Y
EY
Gu
Kenneth V
KV
Snyder
L Nelson
LN
Hopkins
Adnan H
AH
Siddiqui
Elad I
EI
Levy
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D017542:Aneurysm, Ruptured / Q000628:therapy; D016292:Procedural Sedation / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D007431:Intraoperative Complications / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D003287:Contrast Media