Interventional neuroradiology. Recent developments and anaesthesiologic aspects

To summarise recent developments in interventional neuroradiology (INR) and to discuss related anaesthesiologic considerations.

Important Procedures: embolisation of cerebral aneurysms with Guglielmi detachable coils (GDC) as well as intra-arterial thrombolysis and angioplasty for acute ischaemic stroke and chronic atherosclerotic stenosis of cerebral arteries have been recently introduced into clinical practice. Their role in the management of aneurysms and cerebral ischaemia still remains to be defined. Embolisation of strongly vascularised neoplasms, arteriovenous malformations or fistulas and percutaneous transluminal angioplasty of refractory vasospasms after subarachnoid haemorrhage are standard procedures with established indications. The balloon occlusion test of the carotid artery and the WADA test are also frequently performed interventions in INR.

The role of the anaesthetist in INR consists in providing patient comfort by analgesia and sedation, adequate monitoring, maintenance of vital functions and (if required) the management of systemic heparinisation. The patient's underlying condition, the duration and the kind of intervention have to be considered to decide on the anaesthetic management. Most of the procedures can safely be performed under light sedation, which allows continuous neurological evaluation of the patient. Knowledge of the risks and hazards of the different procedures and close collaboration with the neuroradiologist form the basis for appropriate management in case of a potentially fatal ischaemic or haemorrhagic complication that may occur in 1 to 8% of interventions. For prompt control of airway, respiration and blood pressure in these emergencies experienced anaesthesia staff is required.