Semiquantitative analysis of indocyanine green videoangiography for cortical perfusion assessment in superficial temporal artery to middle cerebral artery anastomosis

• Published in: Acta neurochirurgica Vol. 155; no. 4; pp. 599 - 605
• Main Authors: Uchino, Haruto, Nakamura, Toshitaka, Houkin, Kiyohiro, Murata, Jun-ichi, Saito, Hisatoshi, Kuroda, Satoshi
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01-04-2013; Springer Nature B.V
• Subjects: Aged; Anastomosis; Anastomosis, Surgical - methods; Carotid artery; Cerebral Revascularization - methods; Clinical Article - Vascular; Female; Hemodynamics; Humans; Indocyanine Green; Interventional Radiology; Male; Medicine; Medicine & Public Health; Middle Aged; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - surgery; Minimally Invasive Surgery; Neurological complications; Neurology; Neuroradiology; Neurosurgery; Perfusion; Radiography; Surgery; Surgical Orthopedics; Temporal Arteries - diagnostic imaging; Temporal Arteries - surgery; Video-Assisted Surgery; Cerebral ischemia; Indocyanine green; Intraoperative monitoring; Hyperperfusion; STA-MCA anastomosis
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-012-1575-y

Background
Postoperative hyperperfusion may lead to severe neurological complications after superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. However, there are no reliable modalities to predict the occurrence of postoperative hyperperfusion during surgery. The purpose of this study is to evaluate whether a semiquantitative analysis of indocyanine green (ICG) videoangiography could be useful in predicting postoperative hyperperfusion after STA-MCA anastomosis.
Methods
This study included seven patients who underwent STA-MCA anastomosis due to occlusive carotid artery diseases. During surgery, ICG videoangiography was performed before and after bypass procedures, and ICG intensity–time curves were semiquantitatively analyzed to evaluate hemodynamic changes by calculating maximum intensity, time to peak (TTP), and blood flow index (BFI).
Results
Maximum intensity significantly increased from 252.6 ± 132.5 to 351.7 ± 151.9 after bypass (
p
 < 0.001). TTP was significantly shortened from 12.9 ± 4.4 s to 9.8 ± 3.7 s (
p
 < 0.001). Furthermore, BFI significantly increased from 33.9 ± 28.1 to 74.6 ± 88.4 (
p
 < 0.05). Postoperative hyperperfusion was observed in five of seven patients 1 day after surgery. The ratio of BFI before and after bypass procedures was significantly higher in patients with postoperative hyperperfusion than those without, 2.5 ± 1.1 and 1.5 ± 0.4, respectively (
p
 = 0.013).
Conclusions
These findings suggest that semiquantitative analysis of ICG videoangiography is helpful in predicting occurrence of hyperperfusion after STA-MCA anastomosis in patients with occlusive carotid artery diseases.