Endovascular treatment of intracranial aneurysms by using Guglielmi detachable coils in awake patients: safety and feasibility

Object. Embolization of intracranial aneurysms performed using Guglielmi de tachable coils (GDCs) is performed with the patient in a state of general a nesthesia at most centers. Such an approach does not allow intraprocedural evaluation of the patient's neurological status and carries additional risk s associated with general anesthesia and mechanical ventilation. At the aut hors' institution, GDC embolization of intracranial aneurysms is performed in awake patients after administration of sedative and analgesic agents (mi dazolam, fentanyl, morphine, and/or hydromorphone). To determine the feasib ility and safety of this approach, the authors have retrospectively reviewe d their clinical experience. Methods. The authors reviewed the medical records of all patients in whom G DC embolization for the treatment of intracranial aneurysms was undertaken between February 1, 1990 and October 31, 1999. Clinical presentation, medic al comorbidities, anesthetic agents used, intraprocedural complications, an d final procedural outcome were recorded for each patient. Guglielmi detachable coil embolization was attempted in the awake patient i n 150 procedures. Among 92 procedures for unruptured aneurysms, 75 (82%) we re completed without complications. Four procedures were completed with com plications. Of the 92 procedures, 13 were aborted due to patient uncooperat iveness (one patient), complications (three patients), morphological charac teristics of the aneurysm or surrounding vessels that made embolization tec hnically difficult (eight patients), or vasospasm (one patient). Among 58 p rocedures for ruptured aneurysms, the procedure was completed without compl ication in 48 cases (83%). The procedure was completed with complications i n five cases and two patients required induction of general anesthesia duri ng the procedure. Five procedures were aborted because morphological charac teristics of the aneurysm or surrounding vessels made embolization technica lly difficult (two patients) or because of aneurysm rupture (two patients) or the appearance of a transient neurological deficit (one patient). Conclusions. Embolization of intracranial aneurysms performed using GDCs in the awake patient appears to be safe and feasible and allows intraprocedur al evaluation of the patient. Potential advantages, including decreased car diopulmonary morbidity rates, shorter hospital stay, and lower hospital cos ts, still require confirmation by a direct comparison with other anesthetic procedures.