2024 American Academy of Neurology Abstract Website

Savio Batista¹, Jordana Borges², Leonardo Oliveira³, Eric Slawka¹, Stefan Koester⁴, Raphael Bertani⁵, Jhon Bocanegra-Becerra⁶, Marcio Ferreira², Raphael Besborodco⁷, Jose Alberto Almeida⁸
¹Federal University of Rio de Janeiro, ²No Affiliation, ³State University of Ponta Grossa, ⁴Vanderbilt University, ⁵Department of Neurosurgery, University of São Paulo, ⁶Department of Medicine, Health Center of Totorabamba, Ministry of Health, ⁷Rusk Rehabilitation, New York University, ⁸Department of Neurosurgery, Municipal Hospital Miguel Couto

Objective:

Conduct a systematic review and meta-analysis to evaluate the safety of LA for the endovascular treatment of intracranial aneurysms.

Background:

Endovascular treatment of intracranial aneurysms has become increasingly popular in recent years due to its minimally invasive nature and high success rate. Historically, general anesthesia (GA) has been the preferred method for endovascular procedures, but there has been growing interest in the use of local anesthesia (LA) as an alternative. However, concerns remain regarding the safety of LA for these complex procedures.

Design/Methods:

A systematic review of the literature of studies investigating the safety of LA for the endovascular treatment of aneurysms was conducted in accordance with the PRISMA guidelines. PubMed, Cochrane Library, and Embase were queried.

Results:

The analysis included 10 studies, with a total of 964 intracranial aneurysms treated with coil embolization under LA. All cases involved coil embolization via femoral artery puncture. The majority of aneurysms ( 85.3%) were unruptured. In the 9 studies reporting on conversion to GA, the pooled analysis showed a 1% rate (95% CI 0 to 2%; I² = 25%). Complications related to the procedure, not directly related to anesthesia, occurred in 10% of cases (95% CI 7 to 14%; I² = 78%), a rate similar to those reported in the literature for GA. Across all studies, the pooled mortality rate was 0% (95% CI 0% to 1%, CI 95%, I² = 0%), with only 5 reported cases.

Conclusions:

These findings suggest that endovascular treatment of aneurysms under LA is a safe option, with a low rate of conversion to GA and a low mortality rate. Moreover, the rate of complications related to the procedure is similar to those reported in the literature for GA, highlighting the comparable safety profile of LA.