Abstract
Background and PurposeDiagnostic cerebral angiography (DCA) is a widely performed outpatient procedure. Given its minimally invasive nature and low procedural risk, DCA is often performed under conscious sedation (CS). This can either be managed by an anesthesia team (AT) or by the proceduralist with the support of a sedation nurse (SN). While the SN model has the potential to reduce costs and optimize personnel resources, its safety and effectiveness in comparison to the AT model require further exploration. This study aims to compare procedural outcomes, patient safety, and sedation effectiveness between the SN-driven and AT-driven CS models.MethodsA retrospective cohort study was conducted between 06/2023 and 07/2024, involving patients undergoing outpatient DCA under conscious sedation. Based on neuroendovascular surgeons’ discretion, procedures could be scheduled using either the SN or AT sedation model. A total of 334 DCAs were performed during this period, with 52 cases using the SN model. For comparison, 52 matched cases from the AT cohort (n=282) were selected based on age, sex, baseline functional status (modified Rankin Scale), and lower anesthesia risk criteria.ResultsBoth the SN and AT groups included 38/52 (73.1%) females, with a median age of 58 years. Baseline functional status (mRS 0–2) was comparable between the two groups (p=0.475). The SN group had significantly fewer patients with Mallampati >2 (0% vs. 11.5%, p=0.027), previous anesthesia concerns (0% vs. 13.5%, p=0.013), and obstructive sleep apnea (1.9% vs. 21.2%, p=0.004) compared to the AT group, suggesting that the SN cohort had lower anesthesia risk. After adjusting for access site, aortic arch anatomy, number of target vessels, and number of 3D rotational angiographies performed, no significant differences were observed in procedure time (p=0.581), total contrast dye used (p=0.537), or fluoroscopy time (p=0.926). Rates of access site hematoma (1.9% vs. 3.8%, p=0.618), temporary neurological deficits (1.9% vs. 1.9%, p=1.000), and delayed discharge (0% vs. 1.9%, p=1.000) were similar between the two groups.ConclusionsWhen carefully selected by the proceduralist, the SN-driven CS model for outpatient DCA achieved similar procedural effectiveness and safety profiles as the AT-driven model. Further prospective studies with larger sample sizes and more diverse populations are warranted to confirm this observation.DisclosuresA. Aljuboori: None. T. Bielinski: None. S. Doucoure: None. M. Kole: None. C. Schirmer: None. O. Goren: None. P. Hendrix: None.