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AJNR - American Journal of Neuroradiology

Publication Preview: Published November 5, 2009

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American Journal of Neuroradiology
DOI 10.3174/ajnr.A1855

INTERVENTIONAL

Provocative Test with Propofol: Experience in Patients with Cerebral Arteriovenous Malformations Who Underwent Neuroendovascular Procedures

C.E. Feliciano, R. de León-Berra, M.S. Hernández-Gaitán, H.M. Torres, O. Creagh and R. Rodríguez-Mercado

From the Department of Surgery, Section of Neurological Surgery, Neuroendovascular Surgery Program (C.E.F., R.d.L.-B., M.S.H.-G., R.R.-M.); and Department of Anesthesia (H.M.T., O.C.), University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.

Please address correspondence to Caleb E. Feliciano, MD, Department of Surgery, Section of Neurological Surgery, Neuroendovascular Surgery Program, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, Puerto Rico; e-mail: caleb.feliciano{at}upr.edu

BACKGROUND AND PURPOSE: Provocative testing before AVM embolization has been shown to be a predictor of a successful endovascular treatment without neurologic deficits. Propofol has been used previously as an alternative agent in Wada testing with adequate results. The purpose of this study was to show our experience with the use of propofol as a safe and effective alternative to barbiturate provocative testing in AVM embolization procedures.

MATERIALS AND METHODS: A series of 20 patients, undergoing 38 embolization sessions, was treated for cerebral AVMs between November 2007 and February 2009 by endovascular methods. All patients were treated under conscious sedation. Pre-embolization neurologic assessment was performed with provocative testing by using propofol at 7-mg doses by an intra-arterial route after microcathether placement in or near the AVM nidus.

RESULTS: Among these 20 patients, 3 developed transient neurologic deficits after provocative testing, precluding initial or further embolization. One of the patients passing the provocative test developed slight paresis as a result of embolization with n-BCA, resulting in a PPV of 97%.

CONCLUSIONS: Propofol use during provocative testing in AVM embolization procedures represents an effective alternative to barbiturate testing and can have a positive impact in improving safety under sedation.

Abbreviations: TIAs, transient ischemic attacks