Intraoperative Angiographic Assessment of Graft Patency During Extracranial-Intracranial Bypass Procedures

Yanaka, Kiyoyuki; Fujita, Keishi; Noguchi, Shozo; Matsumaru, Yuji; Asakawa, Hiroyuki; Anno, Izumi; Meguro, Kotoo; Nose, Tadao

doi:10.2176/nmc.43.509

Cited by 25 publications

(17 citation statements)

References 17 publications

(19 reference statements)

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“…Intraoperative DSA was first described in the 1960s for cranial procedures and has been used with excellent results for neurovascular disorders since that time 2,22,27) . Used primarily as an adjunct in aneurysm surgery, DSA can reliably evaluate the patency of bypass grafts.…”

Section: Resultsmentioning

confidence: 99%

“…With improvements in technology, intraoperative assessment can be completed in a reliable manner allowing higher early patency rates than the current range of 90 and 96% 9,18,23) . Currently, the primary means of graft assessment after completion of the procedure include 32 and 64 slice multidetector CTA, quantitative magnetic resonance (MR) angiography, and conventional cerebral angiography 6,24,27) . Both CTA and MR angiography provide noninvasive means of assessing bypass patency with results comparable to conventional angiography.…”

Section: Case Twomentioning

confidence: 99%

“…Methods to verify intraoperative patency may identify technical deficiencies and allow the surgeon to correct those problems and improve patency rates. The established methods for intraoperative assessment include observation under an operating microscope, microvascular Doppler and intraoperative digital subtraction angiography (DSA) 1,27) . More recently, indocyanine green (ICG) video angiography has been applied to neurovascular procedures as a simple and safe technique to evaluate the intracranial circulation before and after neurosurgical management 14,16) .…”

Section: Introductionmentioning

confidence: 99%

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Indocyanine Green Videoangiography for Confirmation of Bypass Graft Patency

Schuette

Dannenbaum

Cawley

et al. 2011

J Korean Neurosurg Soc

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Objective : The aim of the study is to determine the efficacy of indocyanine green (ICG) videoangiography for confirmation of vascular anastomosis patency in both extracranial-intracranial and intracranial-intracranial bypasses. Methods : Intraoperative ICG videoangiography was used as a surgical adjunct for 56 bypasses in 47 patients to assay the patency of intracranial vascular anastomosis. These patients underwent a bypass for cerebral ischemia in 31 instances and as an adjunct to intracranial aneurysm surgery in 25. After completion of the bypass, ICG was administered to assess the patency of the graft. The findings on ICG videoangiography were then compared to intraoperative and/or postoperative imaging. Results : ICG provided an excellent visualization of all cerebral arteries and grafts at the time of surgery. Four grafts were determined to be suboptimal and were revised at the time of surgery. Findings on ICG videoangiography correlated with intraoperative and/or postoperative imaging. Conclusion : ICG videoangiography is rapid, effective, and reliable in determining the intraoperative patency of bypass grafts. It provides intraoperative information allowing revision to reduce the incidence of technical errors that may lead to early graft thrombosis.

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Section: Resultsmentioning

confidence: 99%

Section: Case Twomentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Indocyanine Green Videoangiography for Confirmation of Bypass Graft Patency

Schuette

Dannenbaum

Cawley

et al. 2011

J Korean Neurosurg Soc

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show abstract

“…DSA can also reveal the fate of a complex aneurysm following bypass surgery and/or trapping strategies (aneurysmal thrombosis, residual filling) [4]. Drawbacks are represented by its invasiveness, high costs, necessity of ionizing radiation, and prolonged operative time (15-60 min) [4][5][6][7].…”

mentioning

confidence: 99%

Intraoperative tools for cerebral bypass surgery

Esposito

Regli

2018

Acta Neurochir

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“…3,4,22,27,28 While indocyanine green videoangiography or intraoperative DS angiography can be applied to evaluate vascular patency during bypass 27,29 or aneurysm 10,22 surgery, these procedures fail to visualize relative microcirculatory flow or tissue perfusion. Potential neurovascular indications for which a direct or indirect assessment of tissue perfusion can become critical are as follows: identification of clip-related vessel stenosis or occlusion, assessment of bypass patency, or confirmation of adequate flow replacement following revascularization for parent vessel sacrifice (hunterian ligation).…”

mentioning

confidence: 99%

Intraoperative monitoring of cerebral blood flow by laser speckle contrast analysis

Hecht

Woitzik²,

Dreier

et al. 2009

FOC

109

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Object Currently, reliable low-cost and noninvasive techniques to assess cerebral perfusion in the operating room are not available. The authors report on their first clinical experience with laser speckle contrast analysis (LASCA) as a complementary imaging tool for the noninvasive and dynamic assessment of cerebral blood flow (CBF) during neurovascular surgery. The purpose of this preliminary study was to address the general feasibility of LASCA in terms of handling and image quality and to provide an example of its clinical implications. Methods Laser speckle contrast analysis was performed in patients undergoing cerebral revascularization procedures for the treatment of hemodynamic compromise and complex aneurysms. The portable LASCA device was centered over the surgical field, and continuous 5-minute recordings of relative CBF were obtained. In the case of flow augmentation for hemodynamic compromise, CBF monitoring was performed before and after completion of the anastomosis. In the case of flow replacement for parent artery sacrifice, CBF monitoring was performed during consecutive 30-second test occlusions of the radial artery graft after proximal internal carotid artery sacrifice and the subsequent initiation of blood flow through the bypass. Results In all cases, the authors achieved good visualization of relative CBF in addition to flow imaging in both the bypass graft and the cortical vasculature. During a sudden CBF decrease after test occlusion of the radial artery graft and subsequent flow initiation through the bypass, LASCA allowed immediate visualization and measurement of relative CBF in excellent spatiotemporal resolution. Conclusions In this study LASCA offered noninvasive and rapid intraoperative assessment of relative CBF, which can be used for optimizing neurovascular procedures.

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Intraoperative Angiographic Assessment of Graft Patency During Extracranial-Intracranial Bypass Procedures

Cited by 25 publications

References 17 publications

Indocyanine Green Videoangiography for Confirmation of Bypass Graft Patency

Indocyanine Green Videoangiography for Confirmation of Bypass Graft Patency

Intraoperative tools for cerebral bypass surgery

Intraoperative monitoring of cerebral blood flow by laser speckle contrast analysis

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