Feasibility, Safety, and Periprocedural Complications of Pipeline Embolization for Intracranial Aneurysm Treatment Under Conscious Sedation: University at Buffalo Neurosurgery Experience

2015 ◽  
Vol 11 (3) ◽  
pp. 426-430 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Marshall C Cress ◽  
Stephan A Munich ◽  
Ashish Sonig ◽  
Chandan Krishna ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
General Anesthesia ◽  
Radiation Exposure ◽  
Intracranial Aneurysms ◽  
Conscious Sedation ◽  
Contrast Material ◽  
Neurological Complications ◽  
Safe Procedure ◽  
Aneurysm Treatment ◽  
The Mean

Abstract 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%). CONCLUSION 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.

Comparison of General Anesthesia and Conscious Sedation during Computed Tomography–Guided Radiofrequency Ablation of T1a Renal Cell Carcinoma

2018 ◽  
Vol 69 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Hae Jin Kim ◽  
Byung Kwan Park ◽  
In Sun Chung
Keyword(s):  
Renal Cell Carcinoma ◽  
Radiofrequency Ablation ◽  
General Anesthesia ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Conscious Sedation ◽  
Tumour Progression ◽  
Tumour Size ◽  
General Anesthesia Group ◽  
The Mean

Purpose Percutaneous radiofrequency ablation is so painful that this treatment requires pain control such as conscious sedation or general anesthesia. It is still unclear which type of anesthesia is better for treatment outcomes of renal cell carcinoma. This study aimed to compare general anesthesia and conscious sedation in treating patients with renal cell carcinoma with radiofrequency ablation. Methods Between 2010 and 2015, 51 patients with biopsy-proven renal cell carcinomas (<4 cm) were treated with computed tomography–guided radiofrequency ablation. General anesthesia was performed in 41 and conscious sedation was performed in 10 patients. Tumour size, local tumour progression, metastasis, major complication, effective dose, glomerular filtration rate difference, and recurrence-free survival rate were compared between these groups. Results The mean tumour size was 2.1 cm in both groups ( P = .673). Local tumour progression occurred in 0% (0 of 41) of the general anesthesia group, but in 40% (4 of 10) of the conscious sedation group ( P = .001). Metastases in these groups occurred in 2.4% (1 of 41) of the general anesthesia group and 20% (2 of 10) of the conscious sedation group ( P = .094). No major complications developed in either group after the first radiofrequency ablation session. The mean effective doses in these groups were 21.7 mSv and 21.2 mSv, respectively ( P = .868). The mean glomerular filtration rate differences in the general anesthesia and conscious sedation groups were −13.5 mL/min/1.73 m2 and −19.1 mL/min/1.73 m2, respectively ( P = .575). Three-year recurrence-free survival rates in these groups were 97.6% and 60.0%, respectively ( P = .001). Conclusions General anesthesia may provide better intermediate outcomes than conscious sedation in treating small renal cell carcinomas with radiofrequency ablation.

Abstract 2598: Radiation Exposure, Procedure Time And Contrast Load In Patients Referred For Coronary Angiography: Head-to-head Comparison Of Dual Source Ct With Conventional Coronary Angiography.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Carlos A Van Mieghem ◽  
Annick C Weustink ◽  
Marcel Kofflard ◽  
A. Schreve-Steensma ◽  
Niels A Matheijssen ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Radiation Exposure ◽  
Contrast Material ◽  
Conventional Coronary Angiography ◽  
Dual Source Ct ◽  
Procedure Time ◽  
X Ray ◽  
Iodinated Contrast ◽  
Dual Source ◽  
The Mean

Introduction and aim: Dual Source CT (DSCT) scanners, with an increased temporal resolution (83 ms), are becoming widely available. To evaluate the current potential of this scanner in the clinical arena, we performed a head-to-head comparison with conventional coronary angiography (CCA) taking into account the following parameters: radiation exposure, procedure time and contrast load. Methods: During a one-year period (april 2006 to march 2007) we compared a consecutive patient group who underwent DSCT (318 patients, 222 male, mean age 68±11 years) and CCA (352 patients, 258 male, mean age 61±12) respectively. Patients with previous bypass surgery were excluded. In DSCT, the volume of iodinated contrast material was adapted to the scan time. A contrast bolus was injected in an antecubital vein at a flow rate of 5.0 ml/s followed by a saline chaser of 40 ml at 5.0 ml/s. Each tube provided 412 mAs/rot (maximum), and full X-ray tube current was given during 25–70% of the RR-interval. Exposure data were collected using the x-ray dosimetrical reports from DSCT and CCA. Results: The mean procedure time using DSCT and CCA was 16.1±4.7 min and 44.1±25.5 min (p<0.001), respectively. The mean contrast load in DSCT and CCA was 77.9±7.6 ml and 175.3±4.3ml (p<0.001), respectively. The overall radiation exposure for DSCT and CCA was calculated as 15.3±4.0 mSv and 5.7±4.3 mSv, respectively. Radiation exposure with DSCT was significantly lower (p<0.001) in patients with a heart rate of >70 bpm (12.9±3.1 mSv ) as compared with patients with heart rates <70 bpm (16.4±3.8 mSv). Conclusion: In today’s practice currently available DSCT scanners perform favorably as compared with CCA, considering procedure time and patient contrast load. Radiation exposure with DSCT remains higher but should not be considered a major disadvantage taking into account the relatively old age group that generally undergoes coronary angiography and the major benefit of not being exposed to the risks of an invasive procedure.

scholarly journals Endovascular Neurosurgery in the Northern Macro- region of Rio Grande do Sul: Part I

2016 ◽  
Vol 37 (03) ◽  
pp. 167-173
Author(s):  
José Vanzin ◽  
Nério Azambuja Jr ◽  
Leonardo Frighetto ◽  
Alan Frohlich ◽  
Daniel Varela ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Rio Grande ◽  
Interventional Neuroradiology ◽  
Diagnostic Procedures ◽  
Neurological Complications ◽  
Safe Procedure ◽  
Rio Grande Do Sul ◽  
The North

Introduction The city of Passo Fundo, in the north of the Rio Grande do Sul state, has been standing out in the health care field for many years. The state has become a reference in endovascular interventional neuroradiology. We will cover 10 years of experience in this area and divide our observations in 3 parts: cerebral angiograms (part I), carotid angioplasties (part II) and intracranial aneurysms (part III). The goal of part I is to statistically assess the cerebral angiograms, their indications, risks and complications, as well as to do a technical review. Materials and Methods A retrospective study from 2005 to 2015 with a total of 5,567 interventional neuroradiology procedures performed. A total of 4,114 angiograms, 639 embolizations of intracranial aneurysms, 414 carotid angioplasties, 143 embolizations of cerebral arteriovenous malformations, 32 embolizations of dural arteriovenous fistulas, 102 cerebral vasospasm treatments, 21 treatments of epistaxis, 36 embolizations of craniocervical tumor, 25 thrombolysis of ischemic stroke, 18 vertebroplasties and 13 embolizations of arteriovenous malformations of the face. Results A total of 4,084 procedures performed, 21,811 vessels studied, average vase 7.62/2.82 vessel and patient/procedure. Of these, 2,536 were diagnostic procedures and 1,548 angiographic controls. Of the total, 1,188 patients received only an angiogram, 27.14% of which were therapeutic procedures. We obtained a total of 3.89% complications: 2.33% reflection vasovagal, 0.56% allergic skin reaction, anaphylactic shock 0.07%, 0.27% femoral hematoma, 0.26% transient neurological deficit, 0.12% permanent neurological deficit and no case of death. Conclusion Cerebral angiography in adults, children and infants is a safe procedure with low risk of permanent neurological complications.

scholarly journals Complication analysis in nitinol stent-assisted embolization of 486 intracranial aneurysms

2015 ◽  
Vol 123 (2) ◽  
pp. 453-459 ◽  
Author(s):  
Andrew Kelly Johnson ◽  
Stephan A. Munich ◽  
Lee A. Tan ◽  
Daniel Mark Heiferman ◽  
Kiffon Marie Keigher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Aneurysm ◽  
Intracranial Aneurysms ◽  
Giant Aneurysm ◽  
Neurological Complications ◽  
Complication Rates ◽  
Major Complications ◽  
Aneurysm Size ◽  
Aneurysm Treatment ◽  
Independent Risk Factors

OBJECT Stent-assisted embolization (SAE) has broadened the scope of endovascular cerebral aneurysm treatment. The risks associated with stent selection and configuration are poorly defined. In this study, the authors aimed to characterize the risk factors that contribute to complications in SAE of intracranial aneurysms. METHODS Over a 10-year period, a single surgeon treated 486 aneurysms with SAE in which open-cell Neuroform or closed-cell Enterprise stents were used. Single stents were used in 386 cases, overlapping stents were deployed in 80 cases, and Y-configuration stents were used in the remaining 20 cases. All neurological complications, which included transient deficits, were analyzed; disabling strokes and death were considered major complications. The chi-square test and multivariate logistic regression were used to evaluate the influence of aneurysm size and morphology, aneurysm location, stent selection, and stent configuration on complication rates. RESULTS There were 7 deaths (1.4%), 9 major strokes (1.9%), and 18 minor neurological complications (3.7%). For all complications, multivariate analysis revealed that large aneurysm size (10–25 mm; p = 0.01), giant aneurysm size (> 25 mm; p = 0.04), fusiform aneurysm morphology (p = 0.03), and using a Y-configuration stent (p = 0.048) were independent risk factors. For the major complications, independent risk factors included an aneurysm in the posterior circulation (p = 0.02), using an overlapping stent configuration (p = 0.03), and using a Y-configuration stent (p < 0.01). CONCLUSIONS In this series, SAE for cerebral aneurysm treatment carried an acceptable complication rate. With continued innovations in techniques and devices and with increased experience, the complication rates associated with SAE may be even lower in the future.

scholarly journals Complications in the Treatment of Intracranial Aneurysms with Silk Stents: An Analysis of 30 Consecutive Patients

2012 ◽  
Vol 18 (4) ◽  
pp. 413-425 ◽  
Author(s):  
L. Cirillo ◽  
M. Leonardi ◽  
M. Dall'Olio ◽  
C. Princiotta ◽  
A. Stafa ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Mass Effect ◽  
Late Complications ◽  
Giant Aneurysms ◽  
Risk Of Bleeding ◽  
Carotid Siphon ◽  
Aneurysm Treatment ◽  
Vertebrobasilar Circulation

Flow-diverting stents (Silk and PED) have radically changed the approach to intracranial aneurysm treatment from the use of endosaccular materials to use of an extraaneurysmal endoluminal device. However, much debate surrounds the most appropriate indications for the use of FD stents and the problems raised by several possible complications. We analysed our technical difficulties and the early (less than ten days after treatment) and late complications encountered in 30 aneurysms treated comprising 13 giant lesions, 12 large, five with maximum diameters <10 mm and one blister-like aneurysm. In our experience the primary indications for the use of FD stents can be the symptomatic intracavernous giant aneurysms. Although the extracavernous carotid siphon aneurysms have major risk of bleeding, FD stents are indicated clearly explaining the risks to the patient in case of severe mass effect. There is a very complex assessment for aneurysms of the vertebrobasilar circulation.

Use of Pipeline Flex is associated with reduced fluoroscopy time, procedure time, and technical failure compared with the first-generation Pipeline embolization device

2016 ◽  
Vol 9 (2) ◽  
pp. 188-191 ◽  
Author(s):  
Elizabeth J Le ◽  
Timothy Miller ◽  
Yafell Serulle ◽  
Ravishankar Shivashankar ◽  
Gaurav Jindal ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Radiation Exposure ◽  
Delivery System ◽  
First Generation ◽  
Mean Difference ◽  
Fluoroscopy Time ◽  
Technical Failure ◽  
Procedure Time ◽  
Pipeline Embolization Device ◽  
Aneurysm Treatment

BackgroundFlow diversion with the Pipeline embolization device is a well-established method of intracranial aneurysm treatment. However, deployment of the first-generation device (Pipeline Classic) can be technically challenging. The Pipeline Flex contains the same flow-diverting stent with a modified delivery system.ObjectiveTo compare procedural outcomes between the first-generation device (Pipeline Classic) and the Pipeline Flex.MethodsThirty-eight of the first 40 consecutive patients who underwent intracranial aneurysm treatment with the Pipeline Flex and 58 of the most recent 60 consecutive patients who underwent treatment with the Pipeline Classic at our institution were evaluated. Patient demographics, aneurysm characteristics, technical procedural details, and early outcomes were analyzed.ResultsThe two groups were comparable for age, gender, and location of target aneurysms. Use of Pipeline Flex decreased procedure time by 44.2 min (p≤0.001) and fluoroscopy time by 22.0 min (p=0.001) compared with the Pipeline Classic. Similarly, radiation exposure was less in the Flex group with a mean difference of 3473.5 Gy cm2 (p=0.002), while contrast usage was decreased with a mean difference of 22.3 mL (p=0.007). These differences remained significant in multivariate regression analysis. Finally, the rate of device deployment failure was lower in the Flex group (7.1%) than in the Classic group (23.9%) (p=0.034).ConclusionsUse of Pipeline Flex significantly reduces the total procedure and fluoroscopy time, contrast usage, patient radiation exposure, and proportion of recaptured devices in comparison with the Pipeline Classic, probably owing to an enhanced delivery system that allows for more reliable and controlled deployment.

scholarly journals Comparative results of operative and endovascular treatment of intracranial aneurysms

2011 ◽  
Vol 58 (3) ◽  
pp. 49-57
Author(s):  
Igor Nikolic ◽  
Branislav Nestorovic ◽  
Goran Tasic ◽  
Miodrag Rakic ◽  
Vaso Antunovic ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Subarachnoid Haemorrhage ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
International Experience ◽  
Aneurysm Treatment ◽  
Patient Status ◽  
Treatment Analysis ◽  
Comparative Results

Terapeutic protoclol for intracranial aneurysm treatment is very complex. In depand of patient status and anviografic founding we determinate modality and time of treatment. Analysis included 137 patients who were treated in Neurosurgical clinic CCS because sponatenus subarachnoid haemorrhage rigine from aneurysm belading. We performed direct surgery (microsurgery) in 109 patients. In early termine we operated 28 patients (25.69%), in first 24 hours 5 of them. In interemdiare period we performed surgery in 9, and other 72 patient we operated in postpone period. Embolisation was performed in 22 patinet. GOS form embolised patient was 4.636+0.581 and in operated 4.113+1.106 (p<0.05). Cumulative experient of Neurisurgical Clinic CCS and sumation of international experience impose as the best treatment is the treatment which is best known for the physitan.

scholarly journals Rapid Ventricular Pacing as a Safe Procedure for Clipping of Complex Ruptured and Unruptured Intracranial Aneurysms

2021 ◽  
Vol 10 (22) ◽  
pp. 5406
Author(s):  
Josefin Grabert ◽  
Stefanie Huber-Petersen ◽  
Tim Lampmann ◽  
Lars Eichhorn ◽  
Hartmut Vatter ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Troponin T ◽  
Surgical Reconstruction ◽  
Anesthesia Induction ◽  
Safe Procedure ◽  
Ventricular Pacing ◽  
Ruptured Intracranial Aneurysm ◽  
Unruptured Intracranial Aneurysms ◽  
Rapid Ventricular Pacing

Surgical treatment of intracranial aneurysm requires advanced technologies to achieve optimal results. Recently, rapid ventricular pacing (RVP) has been described to be an elegant technique that facilitates clip reconstruction of complex unruptured intracranial aneurysm (uIA). However, there is also a growing need for intraoperative tools to ensure safe clip reconstruction of complex ruptured intracranial aneurysm (rIA). We conducted a retrospective analysis of 17 patients who underwent RVP during surgical reconstruction of complex aneurysms. Nine patients had uIA while eight patients underwent surgery for rIA suffering from consecutive subarachnoid hemorrhage (SAH). Hemodynamic data, critical events, laboratory results, and anesthesia-related complications were evaluated. No complications were reported concerning anesthesia induction and induction times were similar between patients exhibiting uIA or rIA (p = 0.08). RVP induced a significant decline of median arterial pressure (MAP) in both groups (p < 0.0001). However, median MAP before and after RVP was not different in both groups (uIA group: p = 0.27; rIA group: p = 0.18). Furthermore, high-sensitive Troponin T (hsTnT) levels were not increased after RVP in any group. One patient in the rIA group exhibited ventricular fibrillation and required cardiopulmonary resuscitation, but has presented with cardiac arrest due to SAH. Otherwise, no arrhythmias or complications occurred. In summary, our data suggest RVP to be feasible in surgery for ruptured intracranial aneurysms.

scholarly journals Anesthetic recovery assisted by rope at three points in horses

2018 ◽  
Vol 48 (11) ◽  
Author(s):  
Diego Rafael Palma da Silva ◽  
Gabriele Biavaschi Silva ◽  
Flávio Desessards De La Corte ◽  
Karin Erica Brass ◽  
Ricardo Pozzobon ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Surgical Procedures ◽  
Surgical Procedure ◽  
Recovery Time ◽  
Safe Procedure ◽  
Quality Of Recovery ◽  
Anesthetic Drugs ◽  
Time Test ◽  
The Mean

ABSTRACT: This study evaluated the quality of anesthesyc recovery of horses using a three-point assisted method. Sixty-eight horses (37 females and 31 males) of different breeds, age and weight submitted to general anesthesia for abdominal - ABD (n=15), arthroscopy - ART (n=17), other orthopedic - ORT (n=18) and miscellaneous - MIX (n=18) surgical procedures. Isoflurane resulted in shorter recovery time (67.4±25.7min) compared to halothane (88.0±37.8min). The mean duration (±SD) of anesthesia for ABD, ORT, ART and MIXgroups was 166.7 (±14), 54.9 (±5.9), 86.5 (±7.3) and 76.4 (±32.5) minutes (min) respectively. Quality of recovery wasn’t influenced by duration of anesthesia or by use of analgesic, sedative and/or anesthetic drugs or not (p>0.05). Mean standing time (TEst) during anesthetic recovery was 67.5 (±29.9) min in ABD, 44.4 (±27) min in ORT, 42.2 (±23.2) min in ART and 39 (±14.7) min in MIX group. Average number of attempts (Ast) to stand was 1.8 (±0.8) in ABD group, 3.1 (±4.7) in ORT, 1.8 (±1.2) in ART and 1.8 (±1.2) in MIX. Recovery time (TRec) in ABD group was 102.2 (±36.5) min, ORT 70.1 (±36.5) min, ART 72.2 (±24.8) min and MIX group 66.6 (±19.1) min. TRec differed (p<0.05) between ABDand other groups. Three-point assisted recoveryfrom anesthesia showed to be a safe procedure during horses’ recovery. This method is easy to apply and well tolerated by horses regardless of the surgical procedure.

scholarly journals Clinical Efficacy Evaluation of Full-endoscopic Foraminoplasty and Discectomy Under General Anesthesia in the Treatment of L5-S1 Disc Herniation

2020 ◽  
Author(s):  
Dongfang Meng ◽  
Lihe Wang ◽  
Tao Wang ◽  
Ji Tu ◽  
Chenyang Du ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Neurological Complications ◽  
Spinal Diseases ◽  
Efficacy Evaluation ◽  
Postoperative Mri ◽  
Minimally Invasive Surgical ◽  
Endoscopic Discectomy ◽  
Operation Procedure ◽  
Percutaneous Transforaminal Endoscopic Discectomy ◽  
The Mean

Abstract Background: Percutaneous transforaminal endoscopic discectomy (PTED) is a minimally invasive surgical method for the treatment of spinal diseases. However, the operation procedure relied on the radiative interventional technology, and was conducted under local anesthesia. Method: From June 2016 to December 2019, we performed a newly developed full-endoscopic visualized foraminoplasty and discectomy under general anesthesia in 30 patients with L5/S1 LDH. In this retrospective study, the outcomes and neurological complications of this approach were evaluated. Results: The mean visual analog scale (VAS) and Oswestry Disability Index (ODI) were significantly improved after surgery. The postoperative MRI reexamination revealed that the degree of intervertebral disc degeneration of each subject was improved significantly to different degrees as compared with that before surgery. The learning curve showed operative time rapidly decreased over the earlier cases, and then tapered to a steady state in the latter cases. Conclusions: Full-endoscopic foraminoplasty and discectomy under general anesthesia is efficient and safe for the treatment of the L5-S1 disc herniation.Trial registration: N/A

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