Transient Cardiac Arrest Induced by Adenosine: A Tool for Contralateral Clipping of Internal Carotid Artery-Ophthalmic Segment Aneurysms.

Abstract

BACKGROUND:

The disadvantages of a contralateral approach (CA) include deep and narrow surgical corridors and inconsistent ability to achieve proximal control of the supraclinoid internal carotid artery (ICA). However, a CA remains as a microsurgical option for selected ICA-ophthalmic (opht) segment aneurysms.

OBJECTIVE:

To describe transient cardiac arrest induced by adenosine as an alternative tool to obtain proximal vascular control and soften the aneurysm sac in selected patients while performing a CA.

METHODS:

From January 1998 to December 2013, we retrospectively identified 30 patients with ICA-opht segment aneurysms treated through a CA. Of those, 8 patients received an intravenous bolus of adenosine to induce transient cardiac arrest for softening of the aneurysm sac. We reviewed preoperative clinical status, characteristics of the contralateral aneurysm, adenosine doses, asystole time, recovery of normal circulation, outcome, and complications.

RESULTS:

No preoperative cardiac or pulmonary pathologies were found in the study population. All contralateral ICA-opht segment aneurysms were unruptured, small, and saccular in shape. Transient cardiac arrest was induced because it was impossible to apply a temporary clip on the parent contralateral supraclinoid ICA. The median dose of adenosine was 22.5 mg (range, 5-50 mg) and the asystole time ranged from 20 to 40 seconds. All patients (n = 8) had good postoperative outcomes. No brain infarction or cardiac complications appeared postoperatively.

CONCLUSIONS:

In selected patients, transient cardiac arrest induced by adenosine during a contralateral approach allows a brief flow arrest and softening of the aneurysm for safer exposure and clipping.

• Authors: Hugo Andrade-Barazarte, Teemu Luostarinen, Felix Goehre, Juri Kivelev, Behnam Rezai Jahromi, Christopher Ludtka, Hanna Lehto, Rahul Raj, Tarik F Ibrahim, Mika Niemela, Juha E Jääskeläinen, Juha A Hernesniemi
• Journal: World neurosurgery (World Neurosurg) Vol. 84 Issue 6 Pg. 1933-40 (Dec 2015) ISSN: 1878-8769 [Electronic] United States
• PMID: 26341426 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Adenosine

Topics

• Adenosine (administration & dosage)
• Adult
• Carotid Artery, Internal (pathology, surgery)
• Female
• Heart Arrest (chemically induced)
• Humans
• Intracranial Aneurysm (pathology, physiopathology, surgery)
• Male
• Microsurgery
• Middle Aged
• Neurologic Examination
• Neurosurgical Procedures (methods)
• Ophthalmic Artery (pathology, surgery)
• Recovery of Function
• Retrospective Studies
• Surgical Instruments
• Time Factors
• Treatment Outcome
• Vascular Surgical Procedures (methods)