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Adenosine for Temporary Flow Arrest During Intracranial Aneurysm Surgery: A Single Center Retrospective Review.
MedLine Citation:
PMID:  21637138     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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 two-year consecutive experience on 40 aneurysms in 40 patients for whom we used adenosine to achieve temporary arterial occlusion during aneurysm surgery. METHOD:: 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 utilization, post operative angiographic and clinical outcome, cardiac complications, and long term neurological follow-up using 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 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. 36 patients were available for follow-up. Mean follow-up was 12.8 months. The mRS score was 0 for 29 patients at time of last follow-up. 4 patients had a mRS 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.
Authors:
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
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-30
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-6-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Northwestern University, Feinberg School of Medicine, Departments of Neurological Surgery and Anesthesiology, Chicago, IL, USA.
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