General Is Better Than Local Anesthesia During Endovascular Procedures

Abstract

Carlos A. Molina MD, PhD Magdy H. Selim MD, PhD Section Editors: The Case: A patient presents with aphasia and right-sided weakness within 5 hours of onset, and occlusion of the proximal portion of the left middle cerebral artery. Emergent endovascular treatment is indicated. The Questions: (1) Should intubation and artificial ventilation be performed before the procedure? (2) Is local anesthesia safe enough to be used, instead of general anesthesia, during the procedure? The Controversy: General anesthesia is preferable to local anesthesia during cerebral endovascular procedures. There is no doubt that general anesthesia is needed during neuroendovascular interventions such as aneurysm coiling, intracranial stenting, balloon angioplasty (percutaneous transluminal angioplasty), or embolization of arteriovenous malformations. Increasingly, advances in intracranial catheter techniques for endovascular treatment of stroke warrant general anesthesia as well. These microsurgical interventions require the navigation and proper placement of microcatheters, microwires, and devices in cerebral arteries as small as 1 mm in diameter. At the beginning of all these interventions, it is essential to acquire a road map. The angiogram is superimposed on the subsequent fluoroscopic live images to allow proper navigation of microcatheters into the intended vessels. However, patient …