Journal of Neurocritical Care (대한신경집중치료학회지)

The Korean Neurocritical Care Society (대한신경집중치료학회)
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Feasibility, Safety, and Follow-up Angiographic Results of Endovascular Treatment for Non-Selected Ruptured Intracranial Aneurysms Under Local Anesthesia with Conscious Sedation

  • Kang, Jongsoo (Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine) ;
  • Kang, Chul-Hoo (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Roh, Jieun (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Yeom, Jeong A (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Shim, Dong-Hyun (Deaprment of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Young Soo (Department of Neurosurgery, MH Yeonse Hospital) ;
  • Lee, Sang Won (Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of medicine) ;
  • Kim, Young-Soo (Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine) ;
  • Park, Kee Hong (Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine) ;
  • Kim, Chang-Hun (Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine) ;
  • Kim, Soo-Kyoung (Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine) ;
  • Choi, Nack-Cheon (Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine) ;
  • Kwon, Oh-Young (Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine) ;
  • Kang, Heeyoung (Department of Neurology and Institute of Health Science, Gyeongsang National University College of Medicine) ;
  • Baik, Seung Kug (Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine)
  • Received : 2018.10.11
  • Accepted : 2018.11.28
  • Published : 2018.12.30
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Abstract

Background: At most centers, general anesthesia (GA) has been preferred for endovascular treatment (EVT) of ruptured intracranial aneurysms (RIAs). In this study, we analyzed procedural results, clinical outcomes, and follow-up angiographic findings for patients undergoing EVT for RIA under local anesthesia (LA) with conscious sedation (CS). Methods: We retrospectively evaluated 308 consecutive patients who underwent EVT for RIAs at a single institution between June 2009 and February 2017. EVT under LA with CS was considered for all patients with aneurysmal subarachnoid hemorrhage, regardless of Hunt and Hess (HH) scale score. Results: EVT was performed for 320 aneurysms in 308 patients with subarachnoid hemorrhages. The mean patient age was $55.5{\pm}12.6$ years. Moderate (III) and poor (IV, V) HH grades were observed in 75 (24.4%) and 77 patients (25%), respectively. Complete occlusion immediately after EVT was achieved for 270 (84.4%) of 320 aneurysms. Thromboembolic complications and intraprocedural ruptures occurred in 25 (7.8%) and 14 cases (4.3%), respectively. The morbidity rate at discharge (as defined by a modified Rankin scale score of 3 or greater) was 27.3% (84/308), while the mortality rate was 11.7% (36/308). Follow-up angiographic results were available for 210 (68.1%) of 308 patients. Recanalization was observed in 64 (29.3%) of 218 aneurysms in 210 patients. Conclusion: Based on our experience, EVT for RIAs under LA with CS was feasible, regardless of the clinical grade of the subarachnoid hemorrhage. Complication rates and follow-up angiographic results were also comparable to those observed when GA was used to perform the procedure.

Keywords

References

  1. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002;360:1267-74. https://doi.org/10.1016/S0140-6736(02)11314-6
  2. Joung KW, Yang KH, Shin WJ, Song MH, Ham K, Jung SC, et al. Anesthetic consideration for neurointerventional procedures. Neurointervention 2014;9:72-7. https://doi.org/10.5469/neuroint.2014.9.2.72
  3. Davis MJ, Menon BK, Baghirzada LB, Campos-Herrera CR, Goyal M, Hill MD, et al. Anesthetic management and outcome in patients during endovascular therapy for acute stroke. Anesthesiology 2012;116:396-405. https://doi.org/10.1097/ALN.0b013e318242a5d2
  4. Kan P, Jahshan S, Yashar P, Orion D, Webb S, Siddiqui AH, et al. Feasibility, safety, and periprocedural complications associated with endovascular treatment of selected ruptured aneurysms under conscious sedation and local anesthesia. Neurosurgery 2013;72:216-20. https://doi.org/10.1227/NEU.0b013e31827b9183
  5. Park SD, Kim JH, Chang CH, Jung YJ. Procedure-related complication rate for the endovascular treatment of aneurysmal subarachnoid hemorrhage under local anesthesia. J Cerebrovasc Endovasc Neurosurg 2016;18:215-22. https://doi.org/10.7461/jcen.2016.18.3.215
  6. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J 1974;2:656-9. https://doi.org/10.1136/bmj.2.5920.656
  7. Roy D, Milot G, Raymond J. Endovascular treatment of unruptured aneurysms. Stroke 2001;32:1998-2004. https://doi.org/10.1161/hs0901.095600
  8. Brinjikji W, Murad MH, Rabinstein AA, Cloft HJ, Lanzino G, Kallmes DF. Conscious sedation versus general anesthesia during endovascular acute ischemic stroke treatment: a systematic review and meta-analysis. AJNR Am J Neuroradiol 2015;36:525-9. https://doi.org/10.3174/ajnr.A4159
  9. Forrest JB, Rehder K, Cahalan MK, Goldsmith CH. Multicenter study of generalanesthesia. III. Predictors of severe perioperative adverse outcomes. Anesthesiology 1992;76:3-15. https://doi.org/10.1097/00000542-199201000-00002
  10. Griessenauer CJ, Shallwani H, Adeeb N, Gupta R, Rangel- Castilla L, Siddiqui AH, et al. Conscious sedation versus general anesthesia for the treatment of cerebral aneurysms with flow diversion: a matched cohort study. World Neurosurg 2017;102:1-5. https://doi.org/10.1016/j.wneu.2017.02.111
  11. Ogilvy CS, Yang X, Jamil OA, Hauck EF, Hopkins LN, Siddiqui AH, et al. Neurointerventional procedures for unruptured intracranial aneurysms under procedural sedation and local anesthesia: a large-volume, single-center experience. J Neurosurg 2011;114:120-8. https://doi.org/10.3171/2010.3.JNS091384
  12. Park HK, Horowitz M, Jungreis C, Genevro J, Koebbe C, Levy E, et al. Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. AJNR Am J Neuroradiol 2005;26:506-14.
  13. Pierot L, Cognard C, Anxionnat R, Ricolfi F, CLARITY Investigators. Ruptured intracranial aneurysms: factors affecting the rate and outcome of endovascular treatment complications in a series of 782 patients (CLARITY study). Radiology 2010;256:916-23. https://doi.org/10.1148/radiol.10092209
  14. Elijovich L, Higashida RT, Lawton MT, Duckwiler G, Giannotta S, Johnston SC, et al. Predictors and outcomes of intraprocedural rupture in patients treated for ruptured intracranial aneurysms: the CARAT study. Stroke 2008;39:1501-6. https://doi.org/10.1161/STROKEAHA.107.504670
  15. Fiehler J, Byrne JV. Factors affecting outcome after endovascular treatment of intracranial aneurysms. Curr Opin Neurol 2009;22:103-8. https://doi.org/10.1097/WCO.0b013e32831af1c1
  16. Ries T, Siemonsen S, Thomalla G, Grzyska U, Zeumer H, Fiehler J. Long-term follow-up of cerebral aneurysms after endovascular therapy prediction and outcome of retreatment. AJNR Am J Neuroradiol 2007;28:1755-61. https://doi.org/10.3174/ajnr.A0649
  17. Nguyen TN, Hoh BL, Amin-Hanjani S, Pryor JC, Ogilvy CS. Comparison of ruptured vs unruptured aneurysms in recanalization after coil embolization. Surg Neurol 2007;68:19-23. https://doi.org/10.1016/j.surneu.2006.10.021
  18. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003;34:1398-403. https://doi.org/10.1161/01.STR.0000073841.88563.E9
  19. Javadpour M, Silver N. Subarachnoid haemorrhage (spontaneous aneurysmal). BMJ Clin Evid 2009;2009:1213.
  20. Ohkuma H, Tsurutani H, Suzuki S. Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management. Stroke 2001;32:1176-80. https://doi.org/10.1161/01.STR.32.5.1176
  21. Dorhout Mees SM, Molyneux AJ, Kerr RS, Algra A, Rinkel GJ. Timing of aneurysm treatment after subarachnoid hemorrhage: relationship with delayed cerebral ischemia and poor outcome. Stroke 2012;43:2126-9. https://doi.org/10.1161/STROKEAHA.111.639690
  22. Whitfield PC, Kirkpatrick PJ. Timing of surgery for aneurysmal subarachnoidhaemorrhage. Cochrane Database Syst Rev 2001;(2):CD001697.
  23. de Gans K, Nieuwkamp DJ, Rinkel GJ, Algra A. Timing of aneurysm surgery in subarachnoid hemorrhage: a systematic review of the literature. Neurosurgery 2002;50:336-40.
  24. Baltsavias GS, Byrne JV, Halsey J, Coley SC, Sohn MJ, Molyneux AJ. Effects of timing of coil embolization after aneurysmal subarachnoid hemorrhage on procedural morbidity and outcomes. Neurosurgery 2000;47:1320-9; discussion 1329-31. https://doi.org/10.1097/00006123-200012000-00010
  25. Burkle H, Dunbar S, Van Aken H. Remifentanil: a novel, shortacting, mu-opioid. Anesth Analg 1996;83:646-51. https://doi.org/10.1213/00000539-199609000-00038
  26. Goettel N, Bharadwaj S, Venkatraghavan L, Mehta J, Bernstein M, Manninen PH. Dexmedetomidine vs propofol-remifentanil conscious sedation for awake craniotomy: a prospective randomized controlled trial. Br J Anaesth 2016;116:811-21. https://doi.org/10.1093/bja/aew024
  27. Byun SH, Hwang DY, Hong SW, Kim SO. Target-controlled infusion of remifentanil for conscious sedation during spinal anesthesia. Korean J Anesthesiol 2011;61:195-200. https://doi.org/10.4097/kjae.2011.61.3.195
  28. Cannata F, Spinoglio A, Di Marco P, Luzi M, Canneti A, Ricciuti G, et al. Total intravenous anesthesia using remifentanil in extracorporeal shock wave lithotripsy (ESWL). Comparison of two dosages: a randomized clinical trial. Minerva Anestesiol 2014;80:58-65.
  29. van Rooij WJ, Sluzewski M, Beute GN, Nijssen PC. Procedural complications of coiling of ruptured intracranial aneurysms: incidence and risk factors in a consecutive series of 681 patients. AJNR Am J Neuroradiol 2006;27:1498-501.
  30. Bruening R, Mueller-Schunk S, Morhard D, Seelos KC, Brueckmann H, Schmid-Elsaesser R, et al. Intraprocedural thrombus formation during coil placement in ruptured intracranial aneurysms: treatment with systemic application of the glycoprotein IIb/IIIa Antagonist tirofiban. AJNR Am J Neuroradiol 2006;27:1326-31.
  31. Deng J, Zhao Z, Gao G. Periprocedural complications associated with endovascular embolisation of intracranial ruptured aneurysms with matrix coils. Singapore Med J 2007;48:429-33.
  32. Bradac GB, Bergui M, Stura G, Fontanella M, Daniele D, Gozzoli L, et al. Periprocedural morbidity and mortality by endovascular treatment of cerebral aneurysms with GDC: a retrospective 12-year experience of a single center. Neurosurg Rev 2007;30:117-25. https://doi.org/10.1007/s10143-006-0059-z
  33. Yu SC, Wong GK, Wong JK, Poon WS. Endovascular coiling versus neurosurgical clipping for ruptured intracranial aneurysms: significant benefits in clinical outcome and reduced consumption of hospital resources in Hong Kong Chinese patients. Hong Kong Med J 2007;13:271-8.
  34. Nguyen TN, Raymond J, Guilbert F, Roy D, Berube MD, Mahmoud M, et al. Association of endovascular therapy of very small ruptured aneurysms with higher rates of procedurerelated rupture. J Neurosurg 2008;108:1088-92. https://doi.org/10.3171/JNS/2008/108/6/1088
  35. Fiehler J, Boor S, Dorbecker R, Eckert B, Gotz F, Hartmann M, et al. Table for optimization and monitoring of cerebral aneurysm therapy (TOMCAT). Clin Neuroradiol 2008;18:168-76. https://doi.org/10.1007/s00062-008-8021-9
  36. Renowden SA, Benes V, Bradley M, Molyneux AJ. Detachable coil embolisation of ruptured intracranial aneurysms: a single center study, a decade experience. Clin Neurol Neurosurg 2009;111:179-88. https://doi.org/10.1016/j.clineuro.2008.09.026
  37. Linfante I, Etezadi V, Andreone V, DeLeo M, Alehashemi S, Shaw K, et al. Intra-arterial abciximab for the treatment of thrombus formation during coil embolization of intracranial aneurysms. J Neurointerv Surg 2010;2:135-8. https://doi.org/10.1136/jnis.2009.001933
  38. Pierot L, Spelle L, Vitry F, ATENA Investigators. Immediate clinical outcome of patients harboring unruptured intracranial aneurysms treated by endovascular approach: results of the ATENA study. Stroke 2008;39:2497-504. https://doi.org/10.1161/STROKEAHA.107.512756
  39. Cho YD, Lee JY, Seo JH, Kang HS, Kim JE, Jung KH, et al. Intraarterial tirofiban infusion for thromboembolic complication during coil embolization of ruptured intracranial aneurysms. Eur J Radiol 2012;81:2833-8. https://doi.org/10.1016/j.ejrad.2011.11.023
  40. Kang DH, Goh DH, Baik SK, Park J, Kim YS. Morphological predictors of intraprocedural rupture during coil embolization of ruptured cerebral aneurysms: do small basal outpouchings carry higher risk? J Neurosurg 2014;121:605-12. https://doi.org/10.3171/2014.5.JNS132107
  41. Stapleton CJ, Walcott BP, Butler WE, Ogilvy CS. Neurological outcomes following intraprocedural rerupture during coil embolization of ruptured intracranial aneurysms. J Neurosurg 2015;122:128-35. https://doi.org/10.3171/2014.9.JNS14616
  42. Spetzler RF, McDougall CG, Zabramski JM, Albuquerque FC, Hills NK, Russin JJ, et al. The barrow ruptured aneurysm trial: 6-year results. J Neurosurg 2015;123:609-17. https://doi.org/10.3171/2014.9.JNS141749
  43. Fan L, Lin B, Xu T, Xia N, Shao X, Tan X, et al. Predicting intraprocedural rupture and thrombus formation during coiling of ruptured anterior communicating artery aneurysms. J Neurointerv Surg 2017;9:370-5. https://doi.org/10.1136/neurintsurg-2016-012335
  44. Nomura M, Mori K, Tamase A, Kamide T, Seki S, Iida Y, et al. Thromboembolic complications during endovascular treatment of ruptured cerebral aneurysms. Interv Neuroradiol 2018;24:29-39. https://doi.org/10.1177/1591019917739448