Adenosine-induced transient asystole

Abstract

Cerebral aneurysms are an important health issue in the United States, and the mortality rate following aneurysm rupture, or SAH, remains high. The treatment of these aneurysms uses endovascular options which include coil placement, stent assistant coiling and, recently, flow diversion. However, microsurgical clipping remains an option in those aneurysms not suited for endovascular therapy. These are often the more complicated aneurysms such as in large, giant aneurysms or deep-seated aneurysms. Circumferential visualization of the aneurysm, parent vessels, branches, perforators, and other neurovascular structures is important to prevent residual aneurysms or strokes from vessel or perforator occlusion. Decompression of the aneurysm sac is often required and we believe that adenosine-induced transient asystole should be an important option for clipping of complex cerebral aneurysms.

Keywords: adenosine; complex brain aneurysm; transient asystole.

G. Britz, M.D., M.P.H.

Figure 1.

Schematic representation of an anterior communicating artery aneurysm. On the left (pre-adenosine), the large mass does not allow circumferential visualization of the aneurysm, branches, and perforators. On the right (post-adenosine), the aneurysm is now collapsed and the surgeon can identify all the major and important branches and perforators.