The risk factors of trigeminocardiac reflex caused by Onyx embolization during cerebrovascular intervention operation

Abstract

Background Trigeminocardiac reflex (TCR) is a brainstem reflexive response of hemodynamic instability during surgery. However, few risk factor analysis and management strategies of TCR have been highlighted in the literature. The purpose of this study was to demonstrate the risk factors for Onyx embolization during cerebrovascular intervention operation so as to optimize perioperative management and reduce the incidence of TCR. Methods We performed a retrospective study on consecutive patients with Onyx embolization over a 4-years period. According to whether TCR episode, they were divided into TCR group and control group. Cases and controls were compared regarding patient characteristics, comorbidities, hemodynamics and complications. We also constructed several multivariable regression models to analyze the risk factors. Results Among 195 identified patients, 27 patients (13.8%) occurred TCR. During DMSO/Onyx injection, HR and MAP were much lower in the TCR group than control group (P < 0.01). Notably, on univariable analysis, the patients with dural arteriovenous fistula (DAVF) and middle meningeal artery being affected was associated with a higher incidence of TCR (P < 0.01). On multivariable analysis, we also found that significant predictors of TCR were DAVF (OR = 12.78; 95%CI [3.57–45.68]), CCF (OR = 7.65; 95%CI [1.64–35.65]), the lesion which supplied by the middle meningeal artery (OR = 4.24; 95%CI [1.67–10.73]), and bradycardia before embolization (OR = 2.55; 95%CI [1.08–5.99]). Conclusion This study demonstrated that DAVF, CCF, and middle meningeal artery embolism may the risk factors for intraoperative TCR episode during Onyx endovascular embolization. Therefore, it is worth further study to take appropriate measures to block TCR-related risk factors during endovascular embolization. Trial registration: ChiCTR, ChiCTR2000038839; Registered 5 October 2020.