Intraoperative assessment of STA-MCA bypass patency using near-infrared indocyanine green video-angiography: A preliminary study

Ambekar, Sudheer; Babu, Arun; Pandey, Paritosh; Devi, Indira

doi:10.4103/0028-3886.105194

Cited by 12 publications

(8 citation statements)

References 6 publications

(8 reference statements)

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“…Before securing the nal two stitches, we ensured that no thrombosis and no sutures penetrated the wall of the vessel on the opposite side. The patency was veri ed post-bypass through ICG [9,10] . When occlusion occurred at the anastomotic site, we conducted an initial assessment outside the vessel to detect any thrombus formation.…”

Section: Assessment Of Acute Thrombosismentioning

confidence: 99%

Analysis of Rescue Strategies for Acute Thrombosis in Moyamoya Patients during STA-MCA Bypass Surgery and the Literature Review

Xu,

Ni,

Zhou

et al. 2024

Preprint

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Background and objectives: Moyamoya disease is most improtantly treated with superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery, and the intraoperative patency of the reconstructive vessels is critical to the efficacy of the procedure. This study aimed to evaluate the efficacy of intra-arterially infused tirofiban for the treatment of acute thrombosis during STA-MCA bypass surgery and countermeasures for acute thrombosis. Methods: We retrospectively reviewed the clinical and imaging data, surgical procedure, and follow-up outcomes of eight patients who developed acute thrombosis during the surgical procedure. We implemented the different thrombolytic methods to evaluate the optimal thrombosis management during the bypass surgery. After three months, we assessed neurological functions using the modified Rankin Scale (mRS) and conducted a literature review using PubMed. Results: Eight patients (four male patients and four female patients) developed acute thrombosis during the bypass surgery. Of the eight patients, two underwent re-anastomosis after thrombus removal, three received local injections of tirofiban into the anastomosis or the branches of the superficial temporal artery, and three underwent superselective intra-arterial tirofiban infusion using a microcatheter. Thrombosis were resolved, and arteries were recanalized in all patients. The mRS score was 0 in all patients. No major ischemic or hemorrhagic complications occurred. Conclusion: Our treatment methods were efficacious in the management of acute thrombosis. Intra-arterial tirofiban administration seems to be a simple and effective treatment option for acute thrombosis during STA-MCA bypass surgery.

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Section: Assessment Of Acute Thrombosismentioning

confidence: 99%

Analysis of Rescue Strategies for Acute Thrombosis in Moyamoya Patients during STA-MCA Bypass Surgery and the Literature Review

Xu,

Ni,

Zhou

et al. 2024

Preprint

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“…Indocyanine green videoangiography is now widely performed ( 5 ). The patency of the anastomosis is assessed by intravenous ICG injection ( 6 ). However, contrast agents sometimes lead to allergic reactions and it requires a long time for contrast agent metabolism.…”

Section: Introductionmentioning

confidence: 99%

Application of intraoperative infrared thermography in bypass surgery for adult moyamoya syndrome: A preliminary study

Lin

Deng

et al. 2023

Front. Neurol.

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Background and objectivesCerebral revascularization surgery is the mainstay of treatment for moyamoya syndrome (MMS) today, and intraoperative determination of the patency of the revascularized vessel is a critical factor in the success of the procedure. Currently, major imaging modalities include intraoperative indocyanine green (ICG) videoangiography (ICG-VA), digital subtraction angiography (DSA), and vascular ultrasound Doppler. Infrared thermography is a modern imaging modality with non-contact devices for the acquisition and analysis of thermal data. We aimed to investigate the feasibility and advantages of infrared thermography in determining anastomotic patency during MMS surgery.MethodsIndocyanine green videoangiography and infrared thermography were performed simultaneously in 21 patients with MMS who underwent bypass surgery. The detection result of vessel patency was compared, and the feasibility and advantages of infrared thermography were assessed.ResultsThe patency of the anastomosis was accurately determined in 21 patients using either ICG angiography or infrared thermography. In 20 patients, the results of infrared thermography showed that the vascular anastomosis was unobstructed, and there was an agreement with the subsequent results of ICG-VA. In one patient, we suspected inadequate patency after testing the anastomosis with infrared thermography, and the results of ICG-VA evaluation of the anastomosis confirmed that there was indeed an anastomotic obstruction.ConclusionCompared with ICG-VA, infrared thermography might offer an alternative non-invasive, contrast-free option in assessing anastomosis patency compared with ICG-VA, and it is likely to become more widely used in the clinic in the near future.

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“…STA-MCA alters the cerebral blood flow (CBF) perfusion of patients, so methods are needed to analyze the changes in blood flow before and after an operation to assist surgeons in adjusting followup therapeutic schedules at any time according to the operation effect. Raabe et al (6,7) first demonstrated that the dynamic flow of indocyanine green (ICG) in anastomotic vessels can help in determining the patency and direction of intraoperative blood flow (8)(9)(10). A host of studies (11)(12)(13)(14) have proven that intraoperative ICG video angiography (ICG-VA) and current commercial software can be employed to generate time-delayed color maps to monitor regional CBF and evaluate improvements in cortex perfusion around the anastomotic site after bypass.…”

Section: Introductionmentioning

confidence: 99%

Automated Quantitative Analysis of Blood Flow in Extracranial–Intracranial Arterial Bypass Based on Indocyanine Green Angiography

Jiang

Zhang

et al. 2021

Front. Surg.

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Microvascular imaging based on indocyanine green is an important tool for surgeons who carry out extracranial–intracranial arterial bypass surgery. In terms of blood perfusion, indocyanine green images contain abundant information, which cannot be effectively interpreted by humans or currently available commercial software. In this paper, an automatic processing framework for perfusion assessments based on indocyanine green videos is proposed and consists of three stages, namely, vessel segmentation based on the UNet deep neural network, preoperative and postoperative image registrations based on scale-invariant transform features, and blood flow evaluation based on the Horn–Schunck optical flow method. This automatic processing flow can reveal the blood flow direction and intensity curve of any vessel, as well as the blood perfusion changes before and after an operation. Commercial software embedded in a microscope is used as a reference to evaluate the effectiveness of the algorithm in this study. A total of 120 patients from multiple centers were sampled for the study. For blood vessel segmentation, a Dice coefficient of 0.80 and a Jaccard coefficient of 0.73 were obtained. For image registration, the success rate was 81%. In preoperative and postoperative video processing, the coincidence rates between the automatic processing method and commercial software were 89 and 87%, respectively. The proposed framework not only achieves blood perfusion analysis similar to that of commercial software but also automatically detects and matches blood vessels before and after an operation, thus quantifying the flow direction and enabling surgeons to intuitively evaluate the perfusion changes caused by bypass surgery.

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Intraoperative assessment of STA-MCA bypass patency using near-infrared indocyanine green video-angiography: A preliminary study

Abstract: ICGA is an effective technique to assess bypass patency during cerebrovascular surgery. Routine use of ICGA in cerebral bypass surgery improves graft patency and minimizes complications due to graft occlusion.

Cited by 12 publications

References 6 publications

Analysis of Rescue Strategies for Acute Thrombosis in Moyamoya Patients during STA-MCA Bypass Surgery and the Literature Review

Analysis of Rescue Strategies for Acute Thrombosis in Moyamoya Patients during STA-MCA Bypass Surgery and the Literature Review

Application of intraoperative infrared thermography in bypass surgery for adult moyamoya syndrome: A preliminary study

Automated Quantitative Analysis of Blood Flow in Extracranial–Intracranial Arterial Bypass Based on Indocyanine Green Angiography

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