E-014 safety of pipeline embolization device deployment under conscious sedation

Abstract

Introduction/purpose The treatment of wide necked intra-cranial aneurysms using flow diverters including the Pipeline Embolization Device (PED) does not often require catheterization of the aneurysm. Additionally, procedure times are shorter when PEDs are used as compared to when techniques such as stent assisted coiling are used. The utility of general endotracheal anesthesia (GETA) for the deployment of a PED is debatable. We report our experience with GETA and conscious sedation (CS) in a series of patients whose intracranial aneurysms were treated with PED(s). Materials and methods A retrospective analysis of patients with unruptured and ruptured intracranial aneurysms treated using PEDs at two academic hospitals was performed for the period between June 2012 and March 2015. Patient demographics, location of intracranial aneurysm, and the size and number of PEDs deployed were documented. The use of GETA versus CS (using Midalzolam and Fentanyl) for each procedure was noted. The incidence of any peri- and post-operative complications were documented including post-operative ventilator associated pneumonia. Technical aspects including device malposition, corking of the device for removal, device apposition against the walls of the vessel and the need for balloon angioplasty, as well as fluoroscopy time were documented. Results A total of 44 PEDs were deployed in 36 procedures performed on 30 patients (average age, 56 ± 13 years; 5 (14%) male). GETA was utilized in 22 out of the 36 (61%) procedures with one (4.5%) ventilator associated pneumonia identified; there was no instance of difficulty with post-procedure extubation. Stent malpositioning occurred in 1 patient treated under GETA and 7 PEDs, deployed in patients under GETA, required balloon angioplasty for vessel wall apposition. CS was used in the remaining 14 procedures (39%). There was no instance of PED malpositioning in the patients treated under CS. One PED device was corked in a GETA patient and had another PED device successfully placed across the neck of the aneurysm. There was no statistical difference in aneurysm sizes treated in either group. Within the GETA and CS groups there were 28 and 16 PEDs deployed, respectively. Fluoroscopy times were longer in the GETA group when compared to the CS group: 42 ± 220 min vs 30 ± 13 (average minutes ± SD). There were no hemorrhagic or thromboembolic complications in either patient group. Conclusion Conscious sedation may provide an acceptable alternative for the treatment of patients using PED when GETA is not desirable or necessary. Disclosures H. Zacharatos: None. D. Sandhu: None. R. Tummala: None. A. Grande: None. B. Jagadeesan: None.