Conscious Sedation Versus General Anesthesia for the Treatment of Cerebral Aneurysms with Flow Diversion: A Matched Cohort Study

Introduction Flow diversion has become a popular treatment option for a variety of cerebral aneurysms. We sought to compare conscious sedation and general anesthesia for flow diverter placement in a matched cohort study. Methods Patients who underwent flow diverter placement under conscious sedation were matched on the basis of age, sex, American Society of Anesthesiologists classification, aneurysm location, and aneurysm size to patients who received general anesthesia. Results Seventy patients undergoing flow diverter placement under conscious sedation were matched to 70 patients using general anesthesia. There were no statistically significant differences in gender, age, pretreatment modified Rankin Scale scores, or American Society of Anesthesiologists class. Aneurysms were located primarily in the internal carotid artery (87.1%) and posterior circulation (11.4%). Maximal aneurysm diameter and history of aneurysm rupture did not differ between the 2 groups. Duration of flow diverter placement was significantly longer in the general anesthesia group. The number of flow diverters placed was also higher in the general anesthesia group. Complete occlusion was achieved in 75% of aneurysms treated under conscious sedation and 82.4% under general anesthesia. Good functional outcome at last follow-up was recorded in 97.1% of cases of conscious sedation and 96.8% of cases of general anesthesia. The rate of thromboembolic and hemorrhagic neurologic complications was comparable between both groups. Conclusions Placement of a flow diverter can be safely performed under conscious sedation and is associated with reduced procedure length. The ideal candidate is cooperative, requires an intervention that is not too complex, and has an experienced operator performing the intervention.