Adenosine-Assisted Clipping of Intracranial Aneurysms
Background. Temporary parent vessel clip occlusion in aneurysm surgery is not always practical or feasible. Adenosine-induced transient cardiac arrest may serve as an alternative.
Methods. All patients who underwent microsurgical clipping of intracranial aneurysms under adenosine-induced asystole performed by the author between September 2011 and July 2014 were retrospectively reviewed.
Results. A total of 16 craniotomies were performed and 16 aneurysms were clipped under adenosine-induced asystole (in 8 basilar arteries, 7 internal carotid arteries, and 1 middle cerebral artery) in 14 patients (8 females, 6 males). Seven cases were elective and 7 were performed after subarachnoid hemorrhage. The patients’ mean age was 54 years (range, 39–70 years). The indications for adenosine use were proximal control in narrow surgical corridors in 11 cases, aneurysm softening in 4 cases, and aneurysm rupture in 1 case. A single dose was used in 12 patients; 2 patients had multiple boluses. The median (range) total dose was 30 (18–60) mg. Adenosine induced bradycardia with concomitant arterial hypotension in all patients and the majority also had asystole for 5–15 s. Transient cardiac arrhythmias were noted in 1 patient (atrial fibrillation in need of electroconversion after two boluses).
Conclusion. Nine clinical scenarios were identified in which adenosine-induced temporary cardiac arrest and deep hypotension was an effective adjunct to temporary clipping during the microsurgical clipping of intracranial aneurysms.
KeywordsAdenosine Aneurysm Cardiac arrest Carotid artery Basilar artery
The authors do not have any personal or institutional financial interest in the drugs, materials, or devices described in the article.
Grant Information/Other Acknowledgments
No grants have been received by the authors.
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