Adenosine for temporary flow arrest during intracranial aneurysm surgery: A single-center retrospective review

Bernard R. Bendok, Dhanesh K. Gupta, Rudy J. Rahme, Christopher S. Eddleman, Joseph G. Adel, Arun K. Sherma, Daniel L. Surdell, John F. Bebawy, Antoun Koht, H. Hunt Batjer

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background: Clip application for temporary occlusion is not always practical or feasible. Adenosine is an alternative that provides brief periods of flow arrest that can be used to advantage in aneurysm surgery, but little has been published on its utility for this indication. Objective: To report our 2-year consecutive experience with 40 aneurysms in 40 patients for whom we used adenosine to achieve temporary arterial occlusion during aneurysm surgery. Methods: We retrospectively reviewed our clinical database between May 2007 and December 2009. All patients who underwent microsurgical clipping of intracranial aneurysms under adenosine-induced asystole were included. Aneurysm characteristics, reasons for adenosine use, postoperative angiographic and clinical outcome, cardiac complications, and long-term neurological follow-up with the modified Rankin Scale were noted. Results: Adenosine was used for 40 aneurysms (10 ruptured, 30 unruptured). The most common indications for adenosine were aneurysm softening in 17 cases and paraclinoid location in 14 cases, followed by broad neck in 12 cases and intraoperative rupture in 6 cases. Troponins were elevated postoperatively in 2 patients. Echocardiography did not show acute changes in either. Clinically insignificant cardiac arrhythmias were noted in 5 patients. Thirty-six patients were available for follow-up. Mean follow-up was 12.8 months. The modified Rankin Scale score was 0 for 29 patients at the time of the last follow-up. Four patients had an modified Rankin Scale score of 1, and scores of 2 and 3 were found in 2 and 1 patients, respectively. Conclusion: Adenosine appears to allow safe flow arrest during intracranial aneurysm surgery. This can enhance the feasibility and safety of clipping in select circumstances.

Original languageEnglish (US)
Pages (from-to)815-820
Number of pages6
JournalNeurosurgery
Volume69
Issue number4
DOIs
StatePublished - Oct 2011

Fingerprint

Intracranial Aneurysm
Adenosine
Aneurysm
Ruptured Aneurysm
Troponin
Heart Arrest
Surgical Instruments
Echocardiography
Cardiac Arrhythmias
Rupture
Neck
Databases
Safety

Keywords

  • Adenosine
  • Aneurysm
  • Clip
  • Flow arrest
  • Rupture
  • Temporary occlusion

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Adenosine for temporary flow arrest during intracranial aneurysm surgery : A single-center retrospective review. / Bendok, Bernard R.; Gupta, Dhanesh K.; Rahme, Rudy J.; Eddleman, Christopher S.; Adel, Joseph G.; Sherma, Arun K.; Surdell, Daniel L.; Bebawy, John F.; Koht, Antoun; Batjer, H. Hunt.

In: Neurosurgery, Vol. 69, No. 4, 10.2011, p. 815-820.

Research output: Contribution to journalArticle

Bendok, BR, Gupta, DK, Rahme, RJ, Eddleman, CS, Adel, JG, Sherma, AK, Surdell, DL, Bebawy, JF, Koht, A & Batjer, HH 2011, 'Adenosine for temporary flow arrest during intracranial aneurysm surgery: A single-center retrospective review', Neurosurgery, vol. 69, no. 4, pp. 815-820. https://doi.org/10.1227/NEU.0b013e318226632c
Bendok, Bernard R. ; Gupta, Dhanesh K. ; Rahme, Rudy J. ; Eddleman, Christopher S. ; Adel, Joseph G. ; Sherma, Arun K. ; Surdell, Daniel L. ; Bebawy, John F. ; Koht, Antoun ; Batjer, H. Hunt. / Adenosine for temporary flow arrest during intracranial aneurysm surgery : A single-center retrospective review. In: Neurosurgery. 2011 ; Vol. 69, No. 4. pp. 815-820.
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T2 - A single-center retrospective review

AU - Bendok, Bernard R.

AU - Gupta, Dhanesh K.

AU - Rahme, Rudy J.

AU - Eddleman, Christopher S.

AU - Adel, Joseph G.

AU - Sherma, Arun K.

AU - Surdell, Daniel L.

AU - Bebawy, John F.

AU - Koht, Antoun

AU - Batjer, H. Hunt

PY - 2011/10

Y1 - 2011/10

N2 - Background: Clip application for temporary occlusion is not always practical or feasible. Adenosine is an alternative that provides brief periods of flow arrest that can be used to advantage in aneurysm surgery, but little has been published on its utility for this indication. Objective: To report our 2-year consecutive experience with 40 aneurysms in 40 patients for whom we used adenosine to achieve temporary arterial occlusion during aneurysm surgery. Methods: We retrospectively reviewed our clinical database between May 2007 and December 2009. All patients who underwent microsurgical clipping of intracranial aneurysms under adenosine-induced asystole were included. Aneurysm characteristics, reasons for adenosine use, postoperative angiographic and clinical outcome, cardiac complications, and long-term neurological follow-up with the modified Rankin Scale were noted. Results: Adenosine was used for 40 aneurysms (10 ruptured, 30 unruptured). The most common indications for adenosine were aneurysm softening in 17 cases and paraclinoid location in 14 cases, followed by broad neck in 12 cases and intraoperative rupture in 6 cases. Troponins were elevated postoperatively in 2 patients. Echocardiography did not show acute changes in either. Clinically insignificant cardiac arrhythmias were noted in 5 patients. Thirty-six patients were available for follow-up. Mean follow-up was 12.8 months. The modified Rankin Scale score was 0 for 29 patients at the time of the last follow-up. Four patients had an modified Rankin Scale score of 1, and scores of 2 and 3 were found in 2 and 1 patients, respectively. Conclusion: Adenosine appears to allow safe flow arrest during intracranial aneurysm surgery. This can enhance the feasibility and safety of clipping in select circumstances.

AB - Background: Clip application for temporary occlusion is not always practical or feasible. Adenosine is an alternative that provides brief periods of flow arrest that can be used to advantage in aneurysm surgery, but little has been published on its utility for this indication. Objective: To report our 2-year consecutive experience with 40 aneurysms in 40 patients for whom we used adenosine to achieve temporary arterial occlusion during aneurysm surgery. Methods: We retrospectively reviewed our clinical database between May 2007 and December 2009. All patients who underwent microsurgical clipping of intracranial aneurysms under adenosine-induced asystole were included. Aneurysm characteristics, reasons for adenosine use, postoperative angiographic and clinical outcome, cardiac complications, and long-term neurological follow-up with the modified Rankin Scale were noted. Results: Adenosine was used for 40 aneurysms (10 ruptured, 30 unruptured). The most common indications for adenosine were aneurysm softening in 17 cases and paraclinoid location in 14 cases, followed by broad neck in 12 cases and intraoperative rupture in 6 cases. Troponins were elevated postoperatively in 2 patients. Echocardiography did not show acute changes in either. Clinically insignificant cardiac arrhythmias were noted in 5 patients. Thirty-six patients were available for follow-up. Mean follow-up was 12.8 months. The modified Rankin Scale score was 0 for 29 patients at the time of the last follow-up. Four patients had an modified Rankin Scale score of 1, and scores of 2 and 3 were found in 2 and 1 patients, respectively. Conclusion: Adenosine appears to allow safe flow arrest during intracranial aneurysm surgery. This can enhance the feasibility and safety of clipping in select circumstances.

KW - Adenosine

KW - Aneurysm

KW - Clip

KW - Flow arrest

KW - Rupture

KW - Temporary occlusion

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