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  • Feasibility and assessment of the safety of coiling intracranial aneurysms under local anesthesia, Saudi center experience. Hosam Al-Jehani , Fasial AlAbbas, May A. AlHamid, Fadel Molani

    Final Number:
    4065

    Authors:
    May Adel AlHamid

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting - Late Breaking Science

    Introduction: Intracranial aneurysms are found in almost 6% of the population, most being unruptured and asymptomatic . Recent advances in non- invasive imaging , provides us with the necessary tools to screen patients and manage accordingly . Due to their unpredictable course and risk of rupture, early intervention is crucial . Given the fact that most cases are elective procedures , the option of coiling under Local anesthesia helps to facilitate the timely management of these patients.

    Methods: we retrospectively reviewed our patients from February 2016 to February 2018 ,that underwent intracranial aneurysm coiling under local anesthesia to assess for procedural difficulties , post coiling angiographic images , peri - procedural complications , clinical outcome (immediate and at 90 days ) and follow up imaging .

    Results: Over the 24 month period, a total of 64 patients harboring 76 aneurysms were treated in King Fahad Hospital of the University- Khobar, and King Fahad Specialist Hospital - Dammam . After obtaining informed consent, 19 patients were submitted to coiling under local anesthesia. The most frequent location was Anterior communicating artery aneurysm (ACom) Followed by Posterior communicating artery aneurysm (PCom) then followed by Basilar artery ,Superior cerebellar artery, Superior hypophyseal artery, Carotid terminus and Vertebral artery aneurysms. All patients were grade 1 and 2 WFNS SAH. 16 patients had an uneventful coiling achieving RROG of 1 and 2. 3 patients suffered an intra-procedural complicated course. The first patient with ACom aneurysm suffered severe vasospasm manifesting as confusion, necessitating intubation and the procedure was completed under GA. Another patient with an ACom was associated with rebleed, for which the patient was intubated and the coiling was completed under GA. The third patient had an ACom aneurysm complicated by ICA/MCA thrombosis, for which the coiling was completed under local anesthesia and the thrombosis was treated successfully with a stent retriever .

    Conclusions: Coiling under local anesthesia is safe and feasible in low grade SAH patient.

    Patient Care: Coiling under local anesthesia is safe and feasible for low grade SAH patients and might help expedite treatment in centers with no dedicated anesthesia services for such cases.

    Learning Objectives: To identify the feasibility and safety of coiling intracranial aneurysms under local anesthesia

    References:

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