Anaesthesia for Interventional Neuroradiology

Abstract

Interventional neuroradiology (INR) or endovascular neurosurgery is an emerging specialty being a hybrid of traditional neurosurgery and neuroradiology. This specialty is focused on the management of neurovascular diseases and other neurosurgical conditions delivering therapeutic drugs and devices through endovascular access. INR always requires sedation or anaesthesia named non-operating room anaesthesia (NORA). Although interventional procedures cause much less tissue trespass than surgical operations, anaesthetists must deal with some specific challenges: interventional suite personnel are often not used to cooperate with anaesthetists and therefore may not be aware of their needs; anaesthetists may not be fully trained to deal with NORA challenges, and they may not be familiar to many new interventional techniques. This manuscript focuses on the peri-procedural anaesthesiologic management of patients undergoing INR procedures. After a rapid introduction to the field of application of INR, anaesthetic issues are described, sorting them as general considerations applicable to all INR procedures and specific considerations inherent to the three most important and frequent INR procedures: aneurysm coiling, arteriovenous malformations (AVMs) and fistulae (AVFs) embolization and acute ischaemic stroke thrombectomy.