Article
Transient adenosine-induced cardiac arrest during intracranial aneurysm surgery
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Authors
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C. Musahl
- Neurochirurgische Klinik, Klinikum Stuttgart
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H. Henkes
- Klinik für diagnostische und interventionelle Neuroradiologie, Klinikum Stuttgart
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N. Hopf
- Neurochirurgische Klinik, Klinikum Stuttgart
| Published: | June 4, 2012 |
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Outline
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Objective: Complex aneurysms often are not suitable for safe clipping without temporarily decompressing the aneurysm.This may be achieved by temporary clip ligation of the proximal vessel, or with deep hypothermic circulatory arrest on cardiopulmonary bypass. These methods are not always practical or feasible. In these cases adenosine-induced cardiac arrest is an alternative method, which provides a short period of flow arrest that can be used to advantage in aneurysm surgery. Here we describe our experience with this method in four consecutive cases.
Methods: Four patients (3 female, 1 male) with a mean age of 47 years were treated using transient adenosine-induced cardiac arrest for clipping of large ICA aneurysms. All patients underwent thorough preoperative cardiological workup. In addition to the regular operative setup transcutaneous pacemakers, as a precaution for prolonged bradcardia or cardiac arrest, were placed on the patient. Escalating doses of adenosine were given to determine the approximate dose that resulted in 30–45 seconds of asystole. When requested by the surgeon, the dose of adenosine was administered for definitive aneurysm dissection and clipping.
Results: Satisfactory aneurysm decompression through cardiac arrest and subsequent complete clipping was achieved in three cases. In one case only slight size reduction through clipping was possible, followed by endovascular occlusion of the remaining aneurysm. No immediate or delayed complications from the use of adenosine itself were recorded. Delayed clip dislocation resulting in a 50% stenosis of the ICA led to a major stroke with subsequent hemiparesis in one patient.
Conclusions: Transient adenosine-induced cardiac arrest is a reliable method for producing a short period of relative hypotension during aneurysm surgery. With appropriate safety precautions, it is a reasonable alternative method when temporary clipping of the proximal vessel is not possible. This can enhance the feasibility and safety of clipping in select circumstances.
