1
|
Lang S, Hoelter P, Schmidt MA, Mrochen A, Kuramatsu J, Kaethner C, Roser P, Kowarschik M, Doerfler A. Accuracy of Dose-Saving Artificial-Intelligence-Based 3D Angiography (3DA) for Grading of Intracranial Artery Stenoses: Preliminary Findings. Diagnostics (Basel) 2023; 13:diagnostics13040712. [PMID: 36832200 PMCID: PMC9954830 DOI: 10.3390/diagnostics13040712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND AND PURPOSE Based on artificial intelligence (AI), 3D angiography (3DA) is a novel postprocessing algorithm for "DSA-like" 3D imaging of cerebral vasculature. Because 3DA requires neither mask runs nor digital subtraction as the current standard 3D-DSA does, it has the potential to cut the patient dose by 50%. The object was to evaluate 3DA's diagnostic value for visualization of intracranial artery stenoses (IAS) compared to 3D-DSA. MATERIALS AND METHODS 3D-DSA datasets of IAS (nIAS = 10) were postprocessed using conventional and prototype software (Siemens Healthineers AG, Erlangen, Germany). Matching reconstructions were assessed by two experienced neuroradiologists in consensus reading, considering image quality (IQ), vessel diameters (VD1/2), vessel-geometry index (VGI = VD1/VD2), and specific qualitative/quantitative parameters of IAS (e.g., location, visual IAS grading [low-/medium-/high-grade] and intra-/poststenotic diameters [dintra-/poststenotic in mm]). Using the NASCET criteria, the percentual degree of luminal restriction was calculated. RESULTS In total, 20 angiographic 3D volumes (n3DA = 10; n3D-DSA = 10) were successfully reconstructed with equivalent IQ. Assessment of the vessel geometry in 3DA datasets did not differ significantly from 3D-DSA (VD1: r = 0.994, p = 0.0001; VD2:r = 0.994, p = 0.0001; VGI: r = 0.899, p = 0.0001). Qualitative analysis of IAS location (3DA/3D-DSA:nICA/C4 = 1, nICA/C7 = 1, nMCA/M1 = 4, nVA/V4 = 2, nBA = 2) and the visual IAS grading (3DA/3D-DSA:nlow-grade = 3, nmedium-grade = 5, nhigh-grade = 2) revealed identical results for 3DA and 3D-DSA, respectively. Quantitative IAS assessment showed a strong correlation regarding intra-/poststenotic diameters (rdintrastenotic = 0.995, pdintrastenotic = 0.0001; rdpoststenotic = 0.995, pdpoststenotic = 0.0001) and the percentual degree of luminal restriction (rNASCET 3DA = 0.981; pNASCET 3DA = 0.0001). CONCLUSIONS The AI-based 3DA is a resilient algorithm for the visualization of IAS and shows comparable results to 3D-DSA. Hence, 3DA is a promising new method that allows a considerable patient-dose reduction, and its clinical implementation would be highly desirable.
Collapse
Affiliation(s)
- Stefan Lang
- Department of Neuroradiology, University Hospital of Erlangen-Nuremberg, 91054 Erlangen, Germany
- Correspondence: ; Tel.: +49-9131-85-39388
| | - Philip Hoelter
- Department of Neuroradiology, University Hospital of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Manuel Alexander Schmidt
- Department of Neuroradiology, University Hospital of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Anne Mrochen
- Department of Neurology, University Hospital of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Joji Kuramatsu
- Department of Neurology, University Hospital of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Christian Kaethner
- Siemens Healthcare GmbH, Advanced Therapies, Innovation, Siemensstraße 1, 91301 Forchheim, Germany
| | - Philipp Roser
- Siemens Healthcare GmbH, Advanced Therapies, Innovation, Siemensstraße 1, 91301 Forchheim, Germany
| | - Markus Kowarschik
- Siemens Healthcare GmbH, Advanced Therapies, Innovation, Siemensstraße 1, 91301 Forchheim, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University Hospital of Erlangen-Nuremberg, 91054 Erlangen, Germany
| |
Collapse
|
2
|
Huang YC, Kao CC, Lu YH, Chou YY, Lin YK, Tam KW. Effects of Shared Decision-Making with a Patient Decision Aid for Postangiography Hemostasis Method Selection: A Randomized Controlled Trial. J Vasc Interv Radiol 2023; 34:832-839. [PMID: 36632966 DOI: 10.1016/j.jvir.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/20/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To evaluate the effects of shared decision-making (SDM) with a patient decision aid (PtDA) on hemostasis device selection and reduction of decisional conflicts in patients undergoing transfemoral angiography. MATERIALS AND METHODS Patients undergoing angiography were randomized to receive either a standard explanation or the process aid of PtDA for choosing hemostasis devices. The decisional conflict was assessed using the 4-item Sure of myself; Understand information; Risk-benefit ratio; Encouragement (SURE) scale. Differences in demographic variables, clinical variables, and final choice of hemostasis devices were compared via univariate and multivariate logistic regression analyses. RESULTS In total, 158 patients were included-80 in the PtDA group and 78 in the standard group. No difference was found between the 2 groups in terms of patient demographic and clinical variables. The PtDA group scored better on all questions of the SURE scale both individually and collaboratively (P <.001). PtDA intervention (P =.031) and reason for angiography (P =.0006) were the main variables that influenced patient hemostasis device choice in the univariate logistic regression analysis. Reason for angiography remained the only deciding factor that affected patient choice in the multivariate logistic regression analysis (P =.015). CONCLUSIONS Step-by-step guidance and pictorial explanation with the assistance of PtDA led to improvements in patient knowledge but showed no significant impact in multivariate analysis for the influence on the choice of hemostasis device.
Collapse
Affiliation(s)
- Yi-Chun Huang
- Department of Medical Imaging, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chao-Chen Kao
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yueh-Hsun Lu
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yun-Yun Chou
- Shared Decision Making Resource Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Ka-Wai Tam
- Shared Decision Making Resource Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
3
|
Dandapat S, Guerrero WR, Ortega-Gutierrez S. Acute StrokeTreatment in Children: Are Adult Guidelines Applicable? Curr Treat Options Neurol 2022; 24:41-54. [PMID: 35509674 PMCID: PMC9060549 DOI: 10.1007/s11940-022-00707-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of this Review This article provides an overview into acute treatments in stroke which are widely studied and available for adults and their applicability in the pediatric population. Recent Findings Arterial ischemic stroke is an important cause of morbidity and mortality in the pediatric population. Neurological deficits and etiologies are age-dependent and more challenging to diagnose than in the adult population. Advancements in imaging and treatment modalities including increased treatment windows in acute stroke have led to improvement in the diagnosis and management of pediatric arterial ischemic disease. Accordingly, hyperacute treatments, such as endovascular therapy, are becoming increasingly available in an attempt to improve outcomes in children. Summary Significant scientific and technological advances have transformed the hyperacute treatment of stroke in the recent years, allowing for improvement in the diagnosis and treatment of cerebrovascular pathologies in children. Optimization in the approach, and validation of existing stroke pathways/protocols is expected to further advance acute stroke therapy in pediatric patient care. Given that the lifelong individual, family, and societal burden of acute stroke is likely to be greater than in adults because infants and children surviving stroke live more years with disability, we must be knowledgeable about this pathology and the medical and therapeutic options available for this unique population as detailed in this review.
Collapse
Affiliation(s)
- Sudeepta Dandapat
- Department of Neurosciences, Aurora Neuroscience Innovation Institute, St.Luke’s Hospital, Milwaukee, WI
| | - Waldo R. Guerrero
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL
| | - Santiago Ortega-Gutierrez
- Department of Neurology, Radiology and Neurosurgery, University of Iowa Comprehensive Stroke Center, Iowa City, IA
| |
Collapse
|
4
|
Hurford R, Rothwell PM. Prevalence, prognosis, and treatment of atherosclerotic intracranial stenosis in Caucasians. Int J Stroke 2021; 16:248-264. [PMID: 33270537 PMCID: PMC8044631 DOI: 10.1177/1747493020974461] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intracranial atherosclerotic stenosis is a highly prevalent cause of stroke worldwide with important ethnic disparities. Widely considered to be a common cause of stroke in Asian and Afro-Caribbean populations, relatively less is known about the burden and significance of intracranial atherosclerotic stenosis in Caucasians. AIMS We aim to highlight recent insights and advances into the prevalence, prognosis, and treatment of symptomatic and asymptomatic atherosclerotic intracranial atherosclerotic stenosis in Caucasian patients. SUMMARY OF REVIEW We identified 48 articles studying intracranial atherosclerotic stenosis in Caucasian patients with ischemic stroke or transient ischemic attack. Most studies were on hospital-based cohorts of consecutive patients and half were graded as "fair" quality. There was significant variation between studies in the definition of intracranial atherosclerotic stenosis and in the imaging modalities used to detect intracranial atherosclerotic stenosis. Overall, 12.1% of Caucasian patients were found to have any intracranial atherosclerotic stenosis, 6.4% symptomatic intracranial atherosclerotic stenosis and 11.1% asymptomatic intracranial atherosclerotic stenosis, with higher rates at older ages. In studies reporting prognosis, there were 61 and 10 same-territory ischemic strokes in 1000 person-years in patients with symptomatic and asymptomatic intracranial atherosclerotic stenosis, respectively. Percutaneous stenting and angioplasty have not proven superior to intensive medical management in patients with symptomatic intracranial atherosclerotic stenosis. CONCLUSIONS Intracranial atherosclerotic stenosis has previously been neglected as a cause of stroke in Caucasians but is highly prevalent at older ages and frequently discovered with the growing use of noninvasive angiography. Intensive medical therapy is the treatment of choice, but there is a need to develop novel treatments or therapeutic approaches to lower the risk of stroke in higher risk patients.
Collapse
Affiliation(s)
- Robert Hurford
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Peter M Rothwell
- Wolfson Centre for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Lee SJ, Liu B, Rane N, Mitchell P, Dowling R, Yan B. Correlation between CT angiography and digital subtraction angiography in acute ischemic strokes. Clin Neurol Neurosurg 2020; 200:106399. [PMID: 33338821 DOI: 10.1016/j.clineuro.2020.106399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE CT angiography (CTA) is not necessarily performed for all acute ischemic strokes due to variations in national guidelines across different regions. It follows that in the absence of CTA, missed identification of large vessel occlusion (LVO) potentially leads to opportunity lost for endovascular thrombectomy. Although the accuracy of CTA is well validated in chronic arterial stenosis, it has not been adequately investigated in acute ischemic stroke. We aimed to investigate the accuracy of CTA compared with digital subtraction angiography (DSA) in detecting LVO in acute ischemic stroke. METHODS This was a retrospective study of acute ischemic strokes with large vessel occlusion which underwent endovascular thrombectomy. We included patients who had a CTA prior to DSA and did not receive intravenous thrombolysis. Images were reviewed by 2 blinded assessors. Positive predictive value (PPV), and negative predictive value (NPV) of CTA were calculated against DSA. RESULTS Seventy-seven patients were included. The median age was 67 (IQR 57-78) and 46 (59.7 %) were male. Median NIHSS was 18 (IQR 12-22). There were 284 arterial segments categorized into 215 anterior arterial segments in 54 patients and 69 posterior arterial segments in 23 patients. The median time between CTA and DSA was 126 min (IQR 91-153 min). CTA showed PPV of 91.1 % and NPV of 95.1 % compared with DSA. CONCLUSIONS We showed that CTA was reasonably accurate in identifying large vessel occlusion in acute ischemic stroke. We propose that current regional guidelines should include CTA for all acute ischemic strokes.
Collapse
Affiliation(s)
- Su Jin Lee
- Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Australia.
| | - Belinda Liu
- Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Australia.
| | - Neil Rane
- Department of Radiology, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia.
| | - Peter Mitchell
- Department of Radiology, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia.
| | - Richard Dowling
- Department of Radiology, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia.
| | - Bernard Yan
- Department of Radiology, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia; Department of Neurology, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia.
| |
Collapse
|
6
|
Liu X, Zhang S, Liu M, Wang Y, Wu J, Dong Q, Zeng J, Huang Y, Wu J, Xu Y, Chen K, Zhang R, Li B, Liu Y, Peng B, Lu Z, Zhou H, Fan X, Shuai J, Xu G. Chinese guidelines for endovascular management of ischemic cerebrovascular diseases. INTERVENTIONAL NEUROLOGY 2014; 1:171-84. [PMID: 25187777 DOI: 10.1159/000351688] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Endovascular technology was initially applied in treating peripheral vascular disease and was further developed in managing coronary artery disease. During the latest two decades, it has been introduced into the arena of cerebrovascular diseases, which has garnered attention and research interests.
Collapse
Affiliation(s)
- Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Beijing
| | - Suming Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, Beijing
| | - Ming Liu
- Department of Neurology, West China Hospital, West China School of Medicine, Chengdu, Beijing
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Beijing
| | - Jiang Wu
- Department of Neurology, The First Affiliated Hospital of Jilin University, Bethune Medicine School, Jilin University, Changchun, PR China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University School of Medicine, Shanghai, PR China
| | - Jinsheng Zeng
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, PR China
| | - Yining Huang
- Department of Neurology, Peking University First Hospital, Peking University School of Medicine, Beijing
| | - Jian Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, School of Medicine, Zhengzhou University, Zhengzhou, PR China
| | - Kangning Chen
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, PR China
| | - Renliang Zhang
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Beijing
| | - Baomin Li
- Department of Neurology, No. 301 Hospital of People's Liberation Army, Beijing
| | - Yajie Liu
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, PR China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, School of Medicine, Sun Yat-sen University, PR China
| | - Huadong Zhou
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, PR China
| | - Xinying Fan
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Beijing
| | - Jie Shuai
- Department of Neurology, Xinqiao Hospital, Third Military Medical University, Chongqing, PR China
| | - Gelin Xu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Beijing ; on behalf of the Chinese Stroke Society
| |
Collapse
|
7
|
Ferré JC, Raoult H, Breil S, Carsin-Nicol B, Ronzière T, Gauvrit JY. Supra-aortic arteries: three-dimensional time-resolved k-t BLAST contrast-enhanced MRA using a nondedicated body coil at 3 tesla in acute ischemic stroke. J Magn Reson Imaging 2013; 40:1056-63. [PMID: 24222649 DOI: 10.1002/jmri.24466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 09/14/2013] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To assess the image quality and diagnostic performance achieved by using supra-aortic 3D-TR-CE-k-t BLAST MRA and a nondedicated body coil as compared with conventional CE-MRA in patients with acute ischemic stroke. MATERIALS AND METHODS In this prospective study, 36 consecutive patients with a suspected acute ischemic stroke underwent both k-t BLAST MRA and conventional CE-MRA. Image quality was assessed using visual and quantitative criteria and the techniques were compared. Both techniques were compared for degree of visual and quantitative measurement of carotid stenosis. RESULTS Delineation of vessel lumen and overall diagnostic confidence were significantly better with CE-MRA, respectively 3.4 ± 0.5 and 3.3 ± 0.6 (mean score ± SD), than with k-t BLAST MRA, respectively 2.8 ± 0.4 and 2.9 ± 0.5 (P < 0.02). SNR and CNR were significantly higher for k-t BLAST MRA, respectively 33.5 ± 19.3 and 27.9 ± 19.3, than for CE-MRA, respectively 25.7 ± 10 and 20.4 ± 8.4 (P < 0.03). Intertechnique agreement was good for carotid stenosis characterization (κ = .763). For the 14 relevant stenosis, stenosis measurements were highly correlated between techniques (0.96; P < 0.0001). The Bland-Altman plot showed a low bias in assessment of the degree of stenosis (mean bias 2.1% ± 7.7). CONCLUSION k-t BLAST MRA using a nondedicated coil offering and dynamic information was a effective diagnostic tool for detection and characterization of carotid stenosis.
Collapse
Affiliation(s)
- Jean-Christophe Ferré
- CHU Rennes, Department of Neuroradiology, University Hospital of Rennes, Rennes, France
| | | | | | | | | | | |
Collapse
|
8
|
Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJB, Demaerschalk BM, Khatri P, McMullan PW, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44:870-947. [PMID: 23370205 DOI: 10.1161/str.0b013e318284056a] [Citation(s) in RCA: 3203] [Impact Index Per Article: 291.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. METHODS Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. RESULTS The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. CONCLUSIONS Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke remains urgently needed.
Collapse
|
9
|
Chamczuk AJ, Ogilvy CS, Snyder KV, Ohta H, Siddiqui AH, Hopkins LN, Levy EI. Elective stenting for intracranial stenosis under conscious sedation. Neurosurgery 2011; 67:1189-93; discussion 1194. [PMID: 20871450 DOI: 10.1227/neu.0b013e3181efbcac] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Elective stenting for intracranial stenosis is under study as an effective means of reducing stroke risk. At most institutions, these procedures are performed and monitored after the induction of general anesthesia. OBJECTIVE To report our success with elective intracranial stenting and angioplasty performed in conscious patients after the administration of mild sedatives and local anesthetic agents. METHODS We retrospectively evaluated data from 66 patients who underwent elective intracranial stenting for atherosclerosis. Sixty-one procedures were performed under local anesthesia with mild sedation; 3 were performed under general anesthesia, and 2 were converted from local to general anesthesia during the procedure. Intraprocedural neurological changes were monitored and led to reevaluation of technique, immediate reimaging, modifying the endovascular procedure itself, or possibly mandating conversion to general anesthesia. RESULTS Thirty-nine anterior and 27 posterior circulation stenotic segments were treated. Angiographic success was achieved in 95.5% of patients with an overall reduction in stenosis of 75.5 to 22.3%. Percutaneous angioplasty and stenting were used in 58 cases; 8 patients were treated with stenting alone. Three patients (4.9%) developed neurological deficits mandating alteration or adjustment of endovascular technique or immediate postoperative management to avoid permanent sequelae. A total of 8 periprocedural complications occurred, 2 of which resulted in permanent neurological deficit. The overall mortality rate was 3.2%. CONCLUSIONS Stenting of intracranial atherosclerosis performed under conscious sedation is associated with complication rates and effectiveness similar to historical rates for general anesthesia. Conscious sedation confers the additional benefit of continuous neurological assessment during the procedure.
Collapse
Affiliation(s)
- Andrea J Chamczuk
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University New York, Buffalo, New York, USA
| | | | | | | | | | | | | |
Collapse
|
10
|
|