title: Adenosine for temporary flow arrest during intracranial aneurysm surgery: a single-center retrospective review.
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.
  
  
  CONCLUSIONS
  Adenosine appears to allow safe flow arrest during intracranial aneurysm surgery. This can enhance the feasibility and safety of clipping in select circumstances.
authors.affiliation: Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA. bbendok@nmff.org
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bendok
authors.forename: Dhanesh K
authors.initials: DK
authors.lastname: Gupta
authors.forename: Rudy J
authors.initials: RJ
authors.lastname: Rahme
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Eddleman
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Adel
authors.forename: Arun K
authors.initials: AK
authors.lastname: Sherma
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Surdell
authors.forename: John F
authors.initials: JF
authors.lastname: Bebawy
authors.forename: Antoun
authors.initials: A
authors.lastname: Koht
authors.forename: H Hunt
authors.initials: HH
authors.lastname: Batjer
mesh_terms: D000241:Adenosine / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D002560:Cerebrovascular Circulation / Q000187:drug effects; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013525:Surgical Instruments; D014665:Vasodilator Agents / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine