Anesthésie en neuroradiologie interventionnelle : traitement des anévrismes intracrâniens

Intracranial aneurisms can be treated by radiologists by coiling using the remodeling technique. Intravascular stents are now being associated in a majority of cases. In these patients there is an increased risk of stroke by stent thrombosis and emboli. These adverse events must be prevented by a high dose anticoagulant therapy during the procedure and a preoperative treatment with aspirin and clopidogrel. On the down side this medication can cause severe haemorrhage, which should be anticipated. Preoperative evaluation should focus on diagnosis of occult bleeding. Anaesthetists have a pivotal role in the diagnosis and treatment of intra procedural aneurism ruptures. For patients treated after an aneurysm rupture the sole aim of the anaesthetist is to control blood pressure. Hypertension can lead to devastating rebleeding, on the other hand low blood pressure can lead to cerebral ischemia.