scholarly journals Indocyanine green videoangiography for recipient vessel stratification in superficial temporal artery–middle cerebral artery bypass surgery

2020 ◽  
pp. 1-9
Author(s):  
Johannes Goldberg ◽  
Peter Vajkoczy ◽  
Nils Hecht
Keyword(s):  
Blood Flow ◽  
White Light ◽  
Bypass Surgery ◽  
Flow Direction ◽  
Superficial Temporal Artery ◽  
Flow Patterns ◽  
Low Flow ◽  
Indocyanine Green Videoangiography ◽  
Recipient Vessel ◽  
Potential Recipient

OBJECTIVEIn superficial temporal artery–middle cerebral artery (STA-MCA) bypass surgery, recipient vessel properties are likely one of the main reasons for bypass failure. In daily practice, most surgeons select the recipient with the largest diameter. However, selection of the ideal recipient remains debatable because there are no objective selection criteria if multiple potential recipients exist. Here, the authors assessed the benefit of using indocyanine green videoangiography (ICG-VA) to optimize recipient vessel selection in patients undergoing STA-MCA bypass surgery for hemodynamic compromise.METHODSAll patients who had undergone STA-MCA bypass procedures with pre- and postanastomosis ICG-VA between 2010 and 2019 were eligible for inclusion in this study. The primary bypass surgeon was blinded to the preanastomosis ICG-VA. Preanastomosis white-light and ICG-VA images were compared to determine the identifiability of potential recipient vessels and pathological flow patterns. After completion of the anastomosis, a second (postanastomosis) ICG-VA image was used to analyze the flow increase within the chosen recipient based on the vessel diameter, initial recipient blood flow, initial sequence of appearance on ICG-VA, initial blood flow direction within the recipient, and orientation of the bypass graft. ICG-VA, FLOW 800, and intraoperative white-light images, as well as demographic, clinical, and radiographic patient data, were retrospectively analyzed by a clinician who was not directly involved in the patients’ care.RESULTSSixty patients underwent 65 STA-MCA bypass procedures with pre- and postanastomosis ICG-VA. The ICG-VA permitted identification of a significantly higher number of potential recipient vessels (median 4, range 1–9) than the white-light images (median 2, range 1–5; p < 0.001), with detection of pathological flow patterns in 20% of all procedures. No association was found between the diameter and blood flow within potential recipients (Spearman r = 0.07, p = 0.69). After bypass grafting, the highest flow increase was noted in recipients with an initially low flow (p < 0.01), a late appearance (p < 0.01), and an initially retrograde flow direction (p = 0.02). Interestingly, flow increase was not significantly influenced by the recipient diameter (p = 0.09) or graft orientation (p = 0.44).CONCLUSIONSICG-VA facilitates identification of potential recipient vessels and detection of pathological flow patterns. Recipients with an initially low flow, a late appearance, and a retrograde flow seem to bear the highest potential for flow increase, possibly due to a higher hemodynamic need for revascularization.

Changes in superficial temporal artery blood flow and cerebral hemodynamics of moyamoya disease after extracranial-intracranial bypass surgery

2005 ◽  
Vol 25 (1_suppl) ◽  
pp. S120-S120 ◽  
Author(s):  
Shigeru Fujimoto ◽  
Kazunori Toyoda ◽  
Tooru Inoue ◽  
Yoko Yokoyama ◽  
Juro Jinnouchi ◽  
...  
Keyword(s):  
Blood Flow ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Cerebral Hemodynamics ◽  
Artery Blood Flow

Changes in superficial temporal artery blood flow and cerebral hemodynamics after extracranial–intracranial bypass surgery in moyamoya disease and atherothrombotic carotid occlusion

2013 ◽  
Vol 325 (1-2) ◽  
pp. 10-14 ◽  
Author(s):  
Shigeru Fujimoto ◽  
Kazunori Toyoda ◽  
Tooru Inoue ◽  
Juro Jinnouchi ◽  
Takanari Kitazono ◽  
...  
Keyword(s):  
Blood Flow ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Cerebral Hemodynamics ◽  
Carotid Occlusion ◽  
Artery Blood Flow

Indocyanine green videoangiography for the identification of superficial temporal artery branches in EC-IC bypass surgery

2016 ◽  
Vol 158 (3) ◽  
pp. 565-570 ◽  
Author(s):  
Giuseppe Esposito ◽  
Jan-Karl Burkhardt ◽  
Oliver Bozinov ◽  
Luca Regli
Keyword(s):  
Indocyanine Green ◽  
Bypass Surgery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Indocyanine Green Videoangiography

Real-Time Overlapping of Indocyanine Green—Video Angiography With White Light Imaging for Vascular Neurosurgery: Technique, Implementation, and Clinical Experience

2020 ◽  
Vol 19 (4) ◽  
pp. 453-460 ◽  
Author(s):  
Dimitrios Athanasopoulos ◽  
Axel Heimann ◽  
Makoto Nakamura ◽  
Irini Kakaletri ◽  
Oliver Kempski ◽  
...  
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Real Time ◽  
White Light ◽  
Multispectral Imaging ◽  
Tissue Perfusion ◽  
Indocyanine Green Videoangiography ◽  
Black And White ◽  
Surgical Clip ◽  
Vascular Neurosurgery

Abstract BACKGROUND Fluorescent-guided techniques in vascular neurosurgery can be demonstrated via black and white indocyanine green videoangiography (ICG-VA). Multispectral imaging (MFL) is a new method, which overlaps fluorescence with the white light and provides a fluorescent white light augmented reality image to the surgeon. OBJECTIVE To investigate (a) whether MFL can enhance the visualization of the blood-flow with simultaneous visualization of the anatomic structures and (b) if MFL can ergonomically improve the microvascular surgical treatment compared to ICG-VA. METHODS A digital imaging of the blood flow after intravenous injection of ICG on 7 pigs was performed in real time under white light, standard fluorescence, and MFL. The blood flow was interrupted with a surgical clip, demonstrating the blockage of the blood flow. We prospectively included 30 patients with vascular deformities. The vasculature was visualized on the microscope's monitor and through the microscope's eyepiece. RESULTS In the animal experiment, the visualization of the anatomy and the blood flow under MFL produced high resolution images. The occlusion of blood vessels demonstrated sufficiently the blockage of tissue perfusion and its reperfusion after clip removal. During all 30 surgical cases, the MFL technique and the direct delivery of the pseudo-colored image through the eyepiece allowed for enhanced anatomic and dynamic data. CONCLUSION MFL was shown to be superior to the classic ICG-VA, delivering enhanced data and notably improving the workflow due to the simultaneous and precise white light visualization of the blood flow and the surrounding anatomic structures.

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

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhuoyun Jiang ◽  
Yu Lei ◽  
Liqiong Zhang ◽  
Wei Ni ◽  
Chao Gao ◽  
...  
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Bypass Surgery ◽  
Flow Direction ◽  
Blood Perfusion ◽  
Automatic Processing ◽  
Vessel Segmentation ◽  
Commercial Software ◽  
Arterial Bypass ◽  
Before And After

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.

scholarly journals Integration of Indocyanine Green Videoangiography With Operative Microscope: Augmented Reality for Interactive Assessment of Vascular Structures and Blood Flow

2015 ◽  
Vol 11 (2) ◽  
pp. 252-258 ◽  
Author(s):  
Nikolay L Martirosyan ◽  
Jesse Skoch ◽  
Jeffrey R Watson ◽  
G Michael Lemole ◽  
Marek Romanowski ◽  
...  
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Real Time ◽  
Femoral Artery ◽  
White Light ◽  
Near Infrared ◽  
Field Of View ◽  
Fluorescence Angiography ◽  
Indocyanine Green Videoangiography ◽  
Operative Microscope

Abstract BACKGROUND Preservation of adequate blood flow and exclusion of flow from lesions are key concepts of vascular neurosurgery. Indocyanine green (ICG) fluorescence videoangiography is now widely used for the intraoperative assessment of vessel patency. OBJECTIVE Here, we present a proof-of-concept investigation of fluorescence angiography with augmented microscopy enhancement: real-time overlay of fluorescence videoangiography within the white light field of view of conventional operative microscopy. METHODS The femoral artery was exposed in 7 anesthetized rats. The dissection microscope was augmented to integrate real-time electronically processed near-infrared filtered images with conventional white light images seen through the standard oculars. This was accomplished by using an integrated organic light-emitting diode display to yield superimposition of white light and processed near-infrared images. ICG solution was injected into the jugular vein, and fluorescent femoral artery flow was observed. RESULTS Fluorescence angiography with augmented microscopy enhancement was able to detect ICG fluorescence in a small artery of interest. Fluorescence appeared as a bright-green signal in the ocular overlaid with the anatomic image and limited to the anatomic borders of the femoral artery and its branches. Surrounding anatomic structures were clearly visualized. Observation of ICG within the vessel lumens permitted visualization of the blood flow. Recorded video loops could be reviewed in an offline mode for more detailed assessment of the vasculature. CONCLUSION The overlay of fluorescence videoangiography within the field of view of the white light operative microscope allows real-time assessment of the blood flow within vessels during simultaneous surgical manipulation. This technique could improve intraoperative decision making during complex neurovascular procedures.

Arterial Bypass Surgery Using a Spontaneously Formed “Bonnet” Superficial Temporal Artery in a Patient With Symptomatic Common Carotid Artery Occlusion

2010 ◽  
Vol 67 (3) ◽  
pp. onsE316-onsE317 ◽  
Author(s):  
Kenta Aso ◽  
Kuniaki Ogasawara ◽  
Masakazu Kobayashi ◽  
Kenji Yoshida
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Common Carotid Artery ◽  
Bypass Surgery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Arterial Bypass ◽  
Arterial Bypass Surgery

Abstract BACKGROUND: Common carotid artery (CCA) occlusive disease may cause hemodynamic cerebral ischemia resulting in the development of ischemic symptoms. The blood flow in the superficial temporal artery (STA) ipsilateral to the occluded CCA is usually poor, which limits its use as a donor artery for extracranial-intracranial arterial bypass surgery. CLINICAL PRESENTATION: Despite antiplatelet therapy, recurrent transient ischemic attacks manifesting as motor aphasia developed in a 72-year-old man. Neuroradiological imaging revealed misery perfusion in the bilateral cerebral hemispheres caused by left CCA occlusion and right internal carotid artery occlusion. Blood flow from the STA contralateral to the occluded CCA perfused the ipsilateral STA over the midline in a retrograde fashion. INTERVENTION: After confirming the direction and the pressure of the blood flow in the spontaneously formed “bonnet” STA, the STA was anastomosed to a cortical artery in the symptomatic frontal lobe so that blood flow in the ipsilateral STA was supplied from the contralateral STA. The procedure was accomplished without difficulty, and no further ischemic symptoms developed after surgery. Postoperative cerebral angiography demonstrated an increase in collateral flow to the anastomosed bonnet STA and perfusion to an entire territory of the upper trunk of the symptomatic middle cerebral artery via the anastomosis. CONCLUSION: This case suggests that arterial bypass surgery can be performed using a spontaneously formed bonnet STA as a donor in a patient with symptomatic CCA occlusion.

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