[Treatment of intracranial aneurysm in interventional neuroradiology. What problems for the anesthetist?]. / Il trattamento degli aneurismi intracranici in neuroradiologia interventistica. Quali i problemi per l'anestesista?

ABSTRACT

AIM: To outline the most occurring complications during endovascular treatment of intracranial aneurysms. DESIGN: Retrospective review of thirty-four patients treated from October 1994 to February 1996 with the placement of mechanically detachable microcoils inside the aneurysmal sac. SETTING: Interventional neuroradiology suite equipped for anesthetic care. PATIENTS 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%). INTERVENTIONS: 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. MEASUREMENTS 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.