Procedure-related Complication Rate for the Endovascular Treatment of Aneurysmal Subarachnoid Hemorrhage under Local Anesthesia

Abstract

ObjectiveTo report the procedure related complication rate of endovascular treatments (EVTs) performed on patients with aneurysmal subarachnoid hemorrhage (aSAH) under local anesthesia (LA).Materials and MethodsThis study enrolled 186 patients who underwent EVT for ruptured aneurysm under LA from January 2009 to December 2013. Procedure-related complications rate and factors associated with it were analyzed depending on the patients' factors, aneurysm factors and physician factors.ResultsAmong the 186 patients who underwent EVT under LA, the respective rates of thromboembolic complication (TEC) and intraoperative rupture (IOR) were 12.8% (23 cases) and 12.9% (24 cases), respectively. Aneurysm size (≥ 7 mm) was the only risk factor for TEC (p = 0.048).ConclusionCompared to previous result with under general anesthesia (GA), the rate of TEC was similar in patients treated under LA, but the IOR rate was significantly higher. The main reason for increasing IOR is considered as the unexpected patients' motion and in accordance with the unexpected movement of the microinstruments. Therefore, another methods to stabilize the patients or switching from LA to GA may be necessary when performing EVT, to reduce complications.

Risk factors for and outcomes of intraprocedural rupture during endovascular treatment of unruptured intracranial aneurysms

“…In a retrospective study of 189 patients with SAH, the rate of IPR was significantly higher under local anesthesia than general anesthesia 13. This was a result of unexpected patient motion and occurred in accordance with the unexpected movement.…”

Factors related to adverse events during endovascular coil embolization for ruptured cerebral aneurysms

“…Thus, emergent surgery may be a risk factor for the same reason. A previous analysis16 showed that treating a ruptured aneurysm under local anesthesia was inappropriate, with unexpected movement of the patients and the micro-instruments likely the main reason. Another previous study17 showed that small aneurysms were a predictor of IPR, and our data agreed.…”

Evaluation of Vascular Endothelial Growth Factor A and Selected Parameters of Coagulation and Fibrinolysis in a Group of Patients with Subarachnoid Haemorrhage

“…The sensitivity and specificity of the biomarkers analyzed separately are low, but they have increased when combined [13]. Serum levels of Vascular Endothelial Growth Factor A (VEGF-A) in patients diagnosed with SAH are measured to assess the correlation between VEGF-A and the clinical condition of patient [14, 15]. The assessment of coagulation system and fibrinolysis parameters during the SAH shows the activation of these systems and it is sufficient in the evaluation of thromboembolic complications.…”

“…Serum level VEGF-A in patients diagnosed with SAH is measured to assess the correlation between VEGF-A and the clinical condition of a particular patient. This may help with proper therapeutics and better prognosis [14, 15].…”