ADENOSINE-INDUCED TRANSIENT CARDIAC ASYSTOLE ENHANCES PRECISE DEPLOYMENT OF STENT-GRAFTS IN THE THORACIC OR ABDOMINAL-AORTA

Purpose: To present a cardiac asystole technique that assists in the a ccurate deployment of stent-grafts during endovascular repair of thora cic or abdominal aortic aneurysms. Technique: In the anesthetized pati ent, trial doses of intravenous adenosine are delivered until a greate r than or equal to 20-second period of asystole is recorded. The endog raft procedure then proceeds until the device is ready for deployment. The predetermined dose of adenosine is administered, and the device i s deployed during asystole. Adenosine-induced transient asystole has b een utilized in 16 patients undergoing balloon-expandable endograft ex clusion of 6 thoracic aortic and 10 abdominal aortic aneurysms. Asysto le lasted for 20 to 30 seconds, during which time the devices were acc urately deployed without interference from the aortic flow. There were no clinical sequelae of this technique in any patient. Conclusions: P harmacologically induced transient asystole appears to be a safe maneu ver to preclude endograft movement by systolic blood flow. The techniq ue permits precise placement of balloon-expandable stent-grafts and is applicable to self-expanding devices as well. Interventionists may wi sh to incorporate adenosine-induced asystole into their aortic aneurys m exclusion procedures.