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Perioperative Cardiac Complications and 30-Day Mortality in Patients Undergoing Intracranial Aneurysmal Surgery With Adenosine-Induced Flow Arrest: A Retrospective Comparative Study

Khan, Shariq A. MD, FRCA*,‡; McDonagh, David L. MD*; Adogwa, Owoicho MD§; Gokhale, Sankalp MD; Toche, Ulysses N. BS; Verla, Terence BS; Zomorodi, Ali R. MD§; Britz, Gavin W. MD#

doi: 10.1227/NEU.0000000000000258
Research-Human-Clinical Studies

BACKGROUND: Adenosine-induced flow arrest is a technique used to assist in the surgical clipping of complex aneurysms.

OBJECTIVE: To assess the safety associated with adenosine-assisted intracranial aneurysm surgery.

METHODS: Medical records of all patients presenting between January 1, 2009, and December 31, 2012, for intracranial aneurysm surgery were analyzed. Patients were divided into 2 groups based on the intraoperative administration of adenosine: the nonadenosine group (n = 262) and the adenosine group (n = 64). The primary outcome compared between groups included a composite of 30-day mortality and incidences of perioperative cardiac complications (perioperative myocardial infarction or perioperative cardiac arrhythmias).

RESULTS: The study groups were statistically similar except for a difference in the size and location of cerebral aneurysms and the incidence of coronary artery disease. The primary composite outcome occurred in 4.6% and 9.4% of patients in the nonadenosine and adenosine groups, respectively (P = .13). After adjustment for differences in the incidence of coronary artery disease between the 2 groups, the odds of the primary outcome were not significantly different between the groups (adjusted odds ratio = 2.12; 95% confidence interval, 0.76-5.93; P = .15). There were also no significant differences in the durations of hospital and intensive care unit stay between the study groups.

CONCLUSION: Our results suggest that adenosine-assisted intracranial aneurysm surgery is not associated with an increase in perioperative cardiac complications or mortality in patients with low risk of coronary artery disease and may be considered a safe technique to assist clipping of complex aneurysms.

*Department of Anesthesiology;

§Departments of Surgery (Neurosurgery) and Radiology, and

Division of Neurocritical Care, Department of Neurology, Duke University Medical Center, Durham, North Carolina;

Department of Anesthesiology, Singapore General Hospital, Singapore;

Duke University Medical School, Durham, North Carolina;

#Department of Neurosurgery, Methodist Neurological Institute, Houston, Texas

Correspondence: Shariq A. Khan, MD, FRCA, DUMC Box 3094, Durham, NC 27710. E-mail:

Received June 27, 2013

Accepted November 18, 2013

Copyright © by the Congress of Neurological Surgeons