Moderate Sedation for Pipeline Embolization of Posterior Circulation Disease: Technical Note from a Single Center

Vijay M. Ravindra, Julius Griauzde, Jonathan P. Scoville, Craig J. Kilburg, D. Andrew Wilkinson, Clint Christensen, William T. Couldwell, Philipp Taussky

Research output: Contribution to journalArticle

Abstract

Objective: Flow diversion has been an important addition to endovascular neurosurgery, but its use in the posterior circulation remains controversial. Our goal is to describe the safety and efficacy of moderate sedation during flow diversion for posterior circulation lesions (aneurysms or dissecting pseudoaneurysms). Methods: The authors retrospectively reviewed the medical records of all patients who underwent placement of a Pipeline embolization device for a posterior circulation lesion using moderate sedation at a single institution from August 2012 through November 2017. Clinical data and outcomes were evaluated. Results: Fifteen consecutive patients were identified: 8 female, 7 male (mean age 52.2 ± 16.3 years, range 15–81). Eleven lesions were located in the vertebral artery, 1 in the posterior inferior cerebellar artery, 2 in the posterior cerebral artery, and 1 in the basilar artery. All patients underwent flow diversion with Pipeline embolization devices. One patient experienced an acute occlusion of the basilar artery during the procedure that required revascularization. Mean fluoroscopy time was 35.6 ± 16.5 minutes (range 15.5–75). Mean follow-up time was 12.7 ± 8.8 months (range 3–36). No patient had new neurologic deficits in the perioperative or postoperative period. Conversion to general anesthesia was not required in any case. Conclusions: Moderate sedation is safe and feasible in patients undergoing flow diversion for posterior circulation lesions. In addition, its use may allow for more rapid identification of procedural complications, facilitating emergent treatment and decreasing procedure-related morbidity.

LanguageEnglish (US)
Pages131-136
Number of pages6
JournalWorld Neurosurgery
Volume121
DOIs
StatePublished - Jan 1 2019

Fingerprint

Conscious Sedation
Neurologic Manifestations
Aneurysm
Anesthesia
Basilar Artery
Posterior Cerebral Artery
Dissecting Aneurysm
Equipment and Supplies
Perioperative Period
Vertebral Artery
Fluoroscopy
False Aneurysm
Neurosurgery
Postoperative Period
General Anesthesia
Medical Records
Arteries
Morbidity
Safety

Keywords

  • Anesthesia
  • Aneurysm
  • Flow diversion
  • Moderate sedation
  • Neurologic deficit
  • Pipeline embolization device
  • Posterior circulation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Moderate Sedation for Pipeline Embolization of Posterior Circulation Disease : Technical Note from a Single Center. / Ravindra, Vijay M.; Griauzde, Julius; Scoville, Jonathan P.; Kilburg, Craig J.; Wilkinson, D. Andrew; Christensen, Clint; Couldwell, William T.; Taussky, Philipp.

In: World Neurosurgery, Vol. 121, 01.01.2019, p. 131-136.

Research output: Contribution to journalArticle

Ravindra, VM, Griauzde, J, Scoville, JP, Kilburg, CJ, Wilkinson, DA, Christensen, C, Couldwell, WT & Taussky, P 2019, 'Moderate Sedation for Pipeline Embolization of Posterior Circulation Disease: Technical Note from a Single Center' World Neurosurgery, vol. 121, pp. 131-136. https://doi.org/10.1016/j.wneu.2018.09.167
Ravindra, Vijay M. ; Griauzde, Julius ; Scoville, Jonathan P. ; Kilburg, Craig J. ; Wilkinson, D. Andrew ; Christensen, Clint ; Couldwell, William T. ; Taussky, Philipp. / Moderate Sedation for Pipeline Embolization of Posterior Circulation Disease : Technical Note from a Single Center. In: World Neurosurgery. 2019 ; Vol. 121. pp. 131-136.
@article{710e88bf55de4d26af29050fcb24dfaa,
title = "Moderate Sedation for Pipeline Embolization of Posterior Circulation Disease: Technical Note from a Single Center",
abstract = "Objective: Flow diversion has been an important addition to endovascular neurosurgery, but its use in the posterior circulation remains controversial. Our goal is to describe the safety and efficacy of moderate sedation during flow diversion for posterior circulation lesions (aneurysms or dissecting pseudoaneurysms). Methods: The authors retrospectively reviewed the medical records of all patients who underwent placement of a Pipeline embolization device for a posterior circulation lesion using moderate sedation at a single institution from August 2012 through November 2017. Clinical data and outcomes were evaluated. Results: Fifteen consecutive patients were identified: 8 female, 7 male (mean age 52.2 ± 16.3 years, range 15–81). Eleven lesions were located in the vertebral artery, 1 in the posterior inferior cerebellar artery, 2 in the posterior cerebral artery, and 1 in the basilar artery. All patients underwent flow diversion with Pipeline embolization devices. One patient experienced an acute occlusion of the basilar artery during the procedure that required revascularization. Mean fluoroscopy time was 35.6 ± 16.5 minutes (range 15.5–75). Mean follow-up time was 12.7 ± 8.8 months (range 3–36). No patient had new neurologic deficits in the perioperative or postoperative period. Conversion to general anesthesia was not required in any case. Conclusions: Moderate sedation is safe and feasible in patients undergoing flow diversion for posterior circulation lesions. In addition, its use may allow for more rapid identification of procedural complications, facilitating emergent treatment and decreasing procedure-related morbidity.",
keywords = "Anesthesia, Aneurysm, Flow diversion, Moderate sedation, Neurologic deficit, Pipeline embolization device, Posterior circulation",
author = "Ravindra, {Vijay M.} and Julius Griauzde and Scoville, {Jonathan P.} and Kilburg, {Craig J.} and Wilkinson, {D. Andrew} and Clint Christensen and Couldwell, {William T.} and Philipp Taussky",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.wneu.2018.09.167",
language = "English (US)",
volume = "121",
pages = "131--136",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Moderate Sedation for Pipeline Embolization of Posterior Circulation Disease

T2 - World Neurosurgery

AU - Ravindra, Vijay M.

AU - Griauzde, Julius

AU - Scoville, Jonathan P.

AU - Kilburg, Craig J.

AU - Wilkinson, D. Andrew

AU - Christensen, Clint

AU - Couldwell, William T.

AU - Taussky, Philipp

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: Flow diversion has been an important addition to endovascular neurosurgery, but its use in the posterior circulation remains controversial. Our goal is to describe the safety and efficacy of moderate sedation during flow diversion for posterior circulation lesions (aneurysms or dissecting pseudoaneurysms). Methods: The authors retrospectively reviewed the medical records of all patients who underwent placement of a Pipeline embolization device for a posterior circulation lesion using moderate sedation at a single institution from August 2012 through November 2017. Clinical data and outcomes were evaluated. Results: Fifteen consecutive patients were identified: 8 female, 7 male (mean age 52.2 ± 16.3 years, range 15–81). Eleven lesions were located in the vertebral artery, 1 in the posterior inferior cerebellar artery, 2 in the posterior cerebral artery, and 1 in the basilar artery. All patients underwent flow diversion with Pipeline embolization devices. One patient experienced an acute occlusion of the basilar artery during the procedure that required revascularization. Mean fluoroscopy time was 35.6 ± 16.5 minutes (range 15.5–75). Mean follow-up time was 12.7 ± 8.8 months (range 3–36). No patient had new neurologic deficits in the perioperative or postoperative period. Conversion to general anesthesia was not required in any case. Conclusions: Moderate sedation is safe and feasible in patients undergoing flow diversion for posterior circulation lesions. In addition, its use may allow for more rapid identification of procedural complications, facilitating emergent treatment and decreasing procedure-related morbidity.

AB - Objective: Flow diversion has been an important addition to endovascular neurosurgery, but its use in the posterior circulation remains controversial. Our goal is to describe the safety and efficacy of moderate sedation during flow diversion for posterior circulation lesions (aneurysms or dissecting pseudoaneurysms). Methods: The authors retrospectively reviewed the medical records of all patients who underwent placement of a Pipeline embolization device for a posterior circulation lesion using moderate sedation at a single institution from August 2012 through November 2017. Clinical data and outcomes were evaluated. Results: Fifteen consecutive patients were identified: 8 female, 7 male (mean age 52.2 ± 16.3 years, range 15–81). Eleven lesions were located in the vertebral artery, 1 in the posterior inferior cerebellar artery, 2 in the posterior cerebral artery, and 1 in the basilar artery. All patients underwent flow diversion with Pipeline embolization devices. One patient experienced an acute occlusion of the basilar artery during the procedure that required revascularization. Mean fluoroscopy time was 35.6 ± 16.5 minutes (range 15.5–75). Mean follow-up time was 12.7 ± 8.8 months (range 3–36). No patient had new neurologic deficits in the perioperative or postoperative period. Conversion to general anesthesia was not required in any case. Conclusions: Moderate sedation is safe and feasible in patients undergoing flow diversion for posterior circulation lesions. In addition, its use may allow for more rapid identification of procedural complications, facilitating emergent treatment and decreasing procedure-related morbidity.

KW - Anesthesia

KW - Aneurysm

KW - Flow diversion

KW - Moderate sedation

KW - Neurologic deficit

KW - Pipeline embolization device

KW - Posterior circulation

UR - http://www.scopus.com/inward/record.url?scp=85055914398&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055914398&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2018.09.167

DO - 10.1016/j.wneu.2018.09.167

M3 - Article

VL - 121

SP - 131

EP - 136

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -