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

  • Clinical Article - Vascular
  • Published:
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Abstract

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.

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Conflicts of interest

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Authors and Affiliations

  1. Sapporo Asabu Neurosurgical Hospital, North 40 East 1, Higashi-ku, Sapporo, Hokkaido, 007-0840, Japan

    Haruto Uchino, Toshitaka Nakamura, Jun-ichi Murata & Hisatoshi Saito

  2. Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Haruto Uchino & Kiyohiro Houkin

  3. Department of Neurosurgery, Faculty of Medicine, University of Toyama, Toyama, Japan

    Satoshi Kuroda

Authors
  1. Haruto Uchino
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  2. Toshitaka Nakamura
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  3. Kiyohiro Houkin
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  4. Jun-ichi Murata
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  5. Hisatoshi Saito
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  6. Satoshi Kuroda
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Correspondence to Haruto Uchino.

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Comment

STA-MCA and other bypasses are still needed in selected patients with ischemic occlusive disease, and also often provide enough flow when MCA needs to be sacrificed due to unclippable or uncoilable giant or fusiform aneurysms instead of performing a more complex and riskier high-flow bypass. However, especially in chronically ischemic brain there is the danger of sudden hyperperfusion after such a lower flow bypass, which needs attention and actions when noticed. This nice paper not only shows excellent surgical techniques and results accordingly but also the further development of the almost revolutionary ICG angiography which really has improved patient safety over the last few years, and apparently continues to do so with more advancement. Whether using a double anastomosis instead of only one increases the incidence of hyperperfusion needs to be studied in larger series. However, in the present series, none of the five patients with hyperperfusion developed any neurological sequelae and with strict blood pressure limits it resolved within 1 week. We are waiting for further developments of the ICG angiography to show flow measurement in numbers in the oculars of the operating microscope as a tool for more accurate prediction of hyper- or hypoperfusion in the adjacent brain vasculature after performing a bypass.

Mika Niemelä

Helsinki, Finland

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Uchino, H., Nakamura, T., Houkin, K. et al. Semiquantitative analysis of indocyanine green videoangiography for cortical perfusion assessment in superficial temporal artery to middle cerebral artery anastomosis. Acta Neurochir 155, 599–605 (2013). https://doi.org/10.1007/s00701-012-1575-y

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  • DOI: https://doi.org/10.1007/s00701-012-1575-y

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