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Application of intraarterial superselective indocyanine green angiography in bypass surgery for adult moyamoya disease

BACKGROUND: Extracranial-intracranial (EC-IC) bypass surgery is the main treatment approach to moyamoya disease, and an accurate assessment of the patency of anastomosis is critical for successful surgery. So far, the most common way to do this is the intraoperative intravenous indocyanine green (IC...

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Autores principales: Ni, Haojin, Wu, Yiwen, Zhou, Chenhui, Li, Xianru, Zhou, Shengjun, Lan, Wenting, Zhang, Zhimeng, Huang, Yi, Wang, Haifeng, Lin, Jinghui
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10613996/
https://www.ncbi.nlm.nih.gov/pubmed/37909032
http://dx.doi.org/10.3389/fneur.2023.1241760
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author Ni, Haojin
Wu, Yiwen
Zhou, Chenhui
Li, Xianru
Zhou, Shengjun
Lan, Wenting
Zhang, Zhimeng
Huang, Yi
Wang, Haifeng
Lin, Jinghui
author_facet Ni, Haojin
Wu, Yiwen
Zhou, Chenhui
Li, Xianru
Zhou, Shengjun
Lan, Wenting
Zhang, Zhimeng
Huang, Yi
Wang, Haifeng
Lin, Jinghui
author_sort Ni, Haojin
collection PubMed
description BACKGROUND: Extracranial-intracranial (EC-IC) bypass surgery is the main treatment approach to moyamoya disease, and an accurate assessment of the patency of anastomosis is critical for successful surgery. So far, the most common way to do this is the intraoperative intravenous indocyanine green (ICG) video-angiography. Intra-arterial ICG-VA has been applied to treat peripheral cerebral aneurysms, spinal arteriovenous fistulas, and dural arteriovenous fistulas, but few reports have concerned the use of arterial injection of ICG to evaluate anastomotic patency. This research aims to explore the feasibility and effects of catheter-guided superficial temporal artery injection of ICG in the evaluation of anastomotic patency after bypass surgery. METHODS: In this study, 20 patients with moyamoya disease or syndrome who underwent bypass surgery were divided into two groups, one who received intravenous ICG angiography and the other who received intra-arterial ICG angiography, to compare the two injection methods for vascular anastomosis patency. We conducted conventional intraoperative digital subtraction angiography (DSA) in a hybrid operating room during extracranial-intracranial (EC-IC) bypass surgery, including the additional step of injecting ICG into the main trunk of the superficial temporal artery (STA) through a catheter. RESULTS: Intra-arterial injection of indocyanine green video-angiography (ICG-VA) indicated good patency of the vascular anastomosis when compared with conventional digital subtraction angiography (DSA) and intravenous ICG-VA, confirming the feasibility of using the arterial injection of ICG for assessing anastomotic patency. And intra-arterial ICG-VA results in faster visualization than intravenous ICG-VA (p < 0.05). Besides, ICG-VA through arterial injection provided valuable information on the vascular blood flow direction after the bypass surgery, and allowed for visual inspection of the range of cortical brain supply from the superficial temporal artery and venous return from the cortex. Moreover, arterial injection of ICG offered a rapid dye washout effect, reducing the repeat imaging time. CONCLUSION: This study indicates that intra-arterial ICG-VA has good effects in observing the direction of blood flow in blood vessels and the range of cortical brain supply from the STA, which reflects blood flow near the anastomosis and provides additional information that may allow the postoperative prediction of cerebral hyperperfusion syndrome. However, the procedure of intra-arterial ICG-VA is relatively complicated compared to intravenous ICG-VA.
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spelling pubmed-106139962023-10-31 Application of intraarterial superselective indocyanine green angiography in bypass surgery for adult moyamoya disease Ni, Haojin Wu, Yiwen Zhou, Chenhui Li, Xianru Zhou, Shengjun Lan, Wenting Zhang, Zhimeng Huang, Yi Wang, Haifeng Lin, Jinghui Front Neurol Neurology BACKGROUND: Extracranial-intracranial (EC-IC) bypass surgery is the main treatment approach to moyamoya disease, and an accurate assessment of the patency of anastomosis is critical for successful surgery. So far, the most common way to do this is the intraoperative intravenous indocyanine green (ICG) video-angiography. Intra-arterial ICG-VA has been applied to treat peripheral cerebral aneurysms, spinal arteriovenous fistulas, and dural arteriovenous fistulas, but few reports have concerned the use of arterial injection of ICG to evaluate anastomotic patency. This research aims to explore the feasibility and effects of catheter-guided superficial temporal artery injection of ICG in the evaluation of anastomotic patency after bypass surgery. METHODS: In this study, 20 patients with moyamoya disease or syndrome who underwent bypass surgery were divided into two groups, one who received intravenous ICG angiography and the other who received intra-arterial ICG angiography, to compare the two injection methods for vascular anastomosis patency. We conducted conventional intraoperative digital subtraction angiography (DSA) in a hybrid operating room during extracranial-intracranial (EC-IC) bypass surgery, including the additional step of injecting ICG into the main trunk of the superficial temporal artery (STA) through a catheter. RESULTS: Intra-arterial injection of indocyanine green video-angiography (ICG-VA) indicated good patency of the vascular anastomosis when compared with conventional digital subtraction angiography (DSA) and intravenous ICG-VA, confirming the feasibility of using the arterial injection of ICG for assessing anastomotic patency. And intra-arterial ICG-VA results in faster visualization than intravenous ICG-VA (p < 0.05). Besides, ICG-VA through arterial injection provided valuable information on the vascular blood flow direction after the bypass surgery, and allowed for visual inspection of the range of cortical brain supply from the superficial temporal artery and venous return from the cortex. Moreover, arterial injection of ICG offered a rapid dye washout effect, reducing the repeat imaging time. CONCLUSION: This study indicates that intra-arterial ICG-VA has good effects in observing the direction of blood flow in blood vessels and the range of cortical brain supply from the STA, which reflects blood flow near the anastomosis and provides additional information that may allow the postoperative prediction of cerebral hyperperfusion syndrome. However, the procedure of intra-arterial ICG-VA is relatively complicated compared to intravenous ICG-VA. Frontiers Media S.A. 2023-10-16 /pmc/articles/PMC10613996/ /pubmed/37909032 http://dx.doi.org/10.3389/fneur.2023.1241760 Text en Copyright © 2023 Ni, Wu, Zhou, Li, Zhou, Lan, Zhang, Huang, Wang and Lin. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Ni, Haojin
Wu, Yiwen
Zhou, Chenhui
Li, Xianru
Zhou, Shengjun
Lan, Wenting
Zhang, Zhimeng
Huang, Yi
Wang, Haifeng
Lin, Jinghui
Application of intraarterial superselective indocyanine green angiography in bypass surgery for adult moyamoya disease
title Application of intraarterial superselective indocyanine green angiography in bypass surgery for adult moyamoya disease
title_full Application of intraarterial superselective indocyanine green angiography in bypass surgery for adult moyamoya disease
title_fullStr Application of intraarterial superselective indocyanine green angiography in bypass surgery for adult moyamoya disease
title_full_unstemmed Application of intraarterial superselective indocyanine green angiography in bypass surgery for adult moyamoya disease
title_short Application of intraarterial superselective indocyanine green angiography in bypass surgery for adult moyamoya disease
title_sort application of intraarterial superselective indocyanine green angiography in bypass surgery for adult moyamoya disease
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10613996/
https://www.ncbi.nlm.nih.gov/pubmed/37909032
http://dx.doi.org/10.3389/fneur.2023.1241760
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