Interventional neuroradiology (INR) can provide treatments for central nervous system (CNS) diseases, especially for intracranial vascular lesions by endovascular access in order to deliver therapeutic agents, including both drugs and devices. The procedures can be lengthy and uncomfortable and patients require sedation or anesthesia in addition to continuous monitoring of the cardiorespiratory and neurologic systems. The anesthetic management, the occurrence and the treatment of complications are reviewed in 101 patients who underwent a total of 121 INR procedures. Under general endotracheal anesthesia a superselective microcatheter was introduced into the cerebral circulation via the femoral artery. The coaxial catheter was advanced into the lesion with fluroscopic guidance and used to deliver embolic materials into the lesion. Charts were reviewed for information regarding the anesthetic management, monitoring technique, intraoperative complications and the anesthetic intervention. There were documented 22 episodes of anesthetic or radiological technique-related complications. Anesthesia was involved in 7 cases and 15 complications were directly related to the INR. Introduction Interventional neuroradiology (INR) can provide treatments for central nervous system (CNS) diseases by radiological techniques and new therapeutic options were described during the last decades (1). These procedures include embolization of arteriovenous malformations (AVMs), intracranial aneurysms, vascular tumors, balloon occlusion of arteries supplying aneurysms and arteriovenous fistula (2). The goal of this treatment is to prevent the blood flow into the aneurysm sack by filling the aneurysm with coils, using the principles of electrothrombosis and electrolysis (3) or in case of AVMs, the obliteration of the nidus of the AVMs by occlusion feeder vessels (4). The method involves the placement of a catheter into the femoral artery and floating it just proximal to the aneurysm or to the feeding artery of the AVMs.Because of a recent advancement in the field of INR, more anesthesiologists are involved in care of patients undergoing INR procedure. Anesthesiologists have several important concerns when providing care to patients who undergo INR procedures, including maintenance of patient immobility and physiologic stability, manipulating systemic or regional blood flow, managing anticoagulation, treating and managing sudden unexpected complications during the procedure, guiding the medical management of critical care patients during the transport to and from the radiology suites and rapid recovery from the anesthesia and sedation during or immediately after the procedure to facilitate neurologic examination and monitoring (5). The purpose of this study is to review retrospectively the intraoperative management of patients undergoing INR procedures and the occurrence and treatment of any complications encountered. Patients and methods Between 2001 and 2003, 101 patients at our institution underwent 121 INR procedures for the treatment of aneurysm or AVM's (table 1). The clinical records were reviewed and the data collected from the charts included the anesthetic management and monitoring, the neuroradiological techniques and details of intraoperative complications that occurred either as a result of the anesthesia or the procedure. No patient was excluded.
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