Rate and Prognosis of Patients under Conscious Sedation Requiring Emergent Intubation during Neuroendovascular Procedures

A.E. Hassan; U. Akbar; S.A. Chaudhry; W.G. Tekle; R.P. Tummala; G.J. Rodriguez; A.I. Qureshi

doi:10.3174/ajnr.A3385

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Table 1:

Endovascular procedures according to type of anesthesia used

Variables	Procedures Started under General Anesthesia	Procedures Started under Conscious Sedation	Failure of Conscious Sedation Conversion Rate
Total procedures	387	526	9/526 (1.7%)
Type of procedure
Endovascular treatment of cerebral vasospasm	88 (23%)	81 (15.4%)	2 (2.5%)
Extracranial carotid artery stent placement	11 (3%)	172 (32.7%)	1 (0.6%)
Intracranial angioplasty and/or stent placement	30 (8%)	51 (9.7%)	1 (2.0%)
Embolization of ruptured aneurysm	86 (22%)	21 (3.9%)	1 (4.8%)
Embolization of unruptured aneurysm	53 (14%)	28 (5.3%)	1 (3.6%)
Endovascular treatment of acute ischemic stroke	50 (13%)	86 (16.3%)	3 (3.5%)
Embolization of AVM/epistaxis	69 (18%)	87 (16.5%)	0 (0%)
No. of procedures per patient
1	199 (75%)
2	38 (14%)
≥3	28 (11%)

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Table 2:

Comparison of baseline characteristics and outcomes among patients with conscious sedation and planned and unplanned general anesthesia for endovascular procedures

	Patients who Underwent Endovascular Procedures under Conscious Sedation	Patients who Underwent Endovascular Procedures under Planned General Anesthesia	Patients Who Underwent Endovascular Procedures under Unplanned General Anesthesia	PValue^{^a,^b}
No. of patients	387	260	8
Mean age (yr)	60.2 ± 16.7	56 ± 18	53 ± 16	.09
Women	192 (49.6%)	134 (51%)	1 (13%)	.0260
Risk factors
Hypertension	235 (60.7%)	142 (55%)	6 (75%)	.0979
Hyperlipidemia	166 (42.8%)	60 (23%)	3 (38%)	<.0001
Diabetes mellitus	91 (23.5%)	39 (15%)	1 (13%)	.0303
Coronary artery disease	65 (16.8%)	39 (15%)	1 (13%)	.8057
Congestive heart failure	32 (8.3%)	23 (9%)	1 (13%)	.8394
Atrial fibrillation	40 (10.3%)	26 (10%)	0 (0%)	.6630
Previous stroke	67 (17.3%)	30 (12%)	1 (13%)	.0876
Clinical outcome
Favorable outcome (mRS, 0–2)	264 (68.2%)	109 (42%)	4 (50%)	<.0001
Death	17 (4.4%)	45 (17%)	1 (13%)	<.0001

↵a P < .025, adjusting for multiple comparisons using Bonferroni correction.
↵b Note that the possibility of type II error exists in calculating significance due to the small number of patients.

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Table 3:

Demographic, clinical, and procedural characteristics of patients with conscious sedation failure requiring emergent intubation during neuroendovascular procedures

No.	Age (yr)/Sex	Type of Procedure	Medical History	ASA Grade^{^a,^b}	GCS Score^{^b}	Reason for Conversion	Total Procedural Time (min)	mRS at Discharge
1	47/M	Endovascular treatment of cerebral vasospasm	Hypertension	4	13	Movement	79	1
2	56/M	Extracranial carotid artery stent placement	Hypertension, hyperlipidemia, previous stroke	2	14	Movement	68	2
3	45/M	Endovascular treatment of acute ischemic stroke	Hypertension, hyperlipidemia	3	13	Vomiting (airway protection)	172	2
4	33/M	Embolization of ruptured aneurysm	Hypertension	4	13	Re-ruptured aneurysm	198	4
5	86/M	Intracranial angioplasty and/or stent placement	Hypertension, diabetes mellitus, congestive heart failure	2	15	Movement	424	6
6	61/M	Endovascular treatment of acute ischemic stroke	Hypertension, hyperlipidemia, coronary artery disease	3	13	Movement	115	5
7	50/F	Embolization of unruptured aneurysm	None	1	15	Movement	372	2
8	50/F	Endovascular treatment of acute ischemic stroke	None	1	15	Movement	62	2
9	46/M	Endovascular treatment of cerebral vasospasm	None	4	14	Movement	345	4

Note:—ASA indicates American Society of Anesthesiologists; GCS, Glasgow Coma Scale; mRs, modified Rankin scale.
↵a American Society of Anesthesiologists grade: 1 = a healthy patient; 2 = patient with mild systemic disease; 3 = patient with severe systemic disease; 4 = patient with severe systemic disease that is a constant threat to life; 5 = moribund patient who is not expected to survive without the operation; 6 = declared brain-dead patient whose organs are being removed for donor purposes.
↵b Prior to procedure.