Intensive care unit management of interventional neuroradiology patients

The ICU management of patients undergoing endovascular procedures is complex and varied. It depends not only on the underlying disease process but on the exact nature of the procedure performed, the procedure's success, and whether or not there were any procedural complications, however minor. As a result, there are few class I data to support much of what is done. In fact, most management techniques are drawn from other settings and anecdotal experience. We have highlighted just a few of the issues that arise. As an increasing number of endovascularly treated patients find their way into ICUs, it should be increasingly important to examine whether the treatments used are ideal and, if not, how they can be improved on. This is likely to require multicenter collaboration as well as a change in the way society views the neurologically injured patient. Currently, many states prohibit the enrollment of comatose patients into randomized clinical trials because they do not recognize next of kin assent as sufficient. We can only hope that as the debate rages over quality in health care, comatose patients are also allowed to participate in the fruits of evidenced-based approaches.