Indocyanine-green videoangiogram to assess collateral circulation before arterial sacrifice for management of complex vascular and neoplastic lesions

Technical note

Daniel L. Kim, Aaron Cohen-Gadol

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective: Generally, the sacrifice of arteries that perfuse normal brain parenchyma is avoided. However, there are instances when it is necessary to take certain distal arteries to adequately perform tumor resections or secure vascular lesions. Deciding whether the sacrifice of such arteries is safe can be difficult. Methods: We present four cases demonstrating the use of indocyanine green (ICG) videoangiography to assess collateral circulation before sacrifice of a distal artery. Two cases involved meningiomas with intimately associated arteries; one case involved a distal middle cerebral artery aneurysm that was not amenable to clip reconstruction, requiring trapping; and another case required complex clip reconstruction of a dysplastic middle cerebral artery aneurysm. Results: In all four cases, ICG videoangiography provided excellent real-time demonstration of sufficient collateral flow and retrograde filling after temporary occlusion of the artery in question. The relevant artery was sacrificed in each case, and all patients did well with no evidence of ischemia. Conclusions: Although this is a limited experience and cannot prove the safety of arterial sacrifice in all situations, our series demonstrates the potential usefulness of ICG videoangiography in assessing collateral arterial flow before sacrifice of distal cerebral arteries.

Original languageEnglish
JournalWorld Neurosurgery
Volume79
Issue number2
DOIs
StatePublished - Feb 2013

Fingerprint

Collateral Circulation
Indocyanine Green
Blood Vessels
Arteries
Intracranial Aneurysm
Surgical Instruments
Cerebral Arteries
Meningioma
Ischemia
Safety
Brain

Keywords

  • Arterial sacrifice
  • Cerebral artery
  • Collateral circulation
  • Indocyanine green angiogram

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

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title = "Indocyanine-green videoangiogram to assess collateral circulation before arterial sacrifice for management of complex vascular and neoplastic lesions: Technical note",
abstract = "Objective: Generally, the sacrifice of arteries that perfuse normal brain parenchyma is avoided. However, there are instances when it is necessary to take certain distal arteries to adequately perform tumor resections or secure vascular lesions. Deciding whether the sacrifice of such arteries is safe can be difficult. Methods: We present four cases demonstrating the use of indocyanine green (ICG) videoangiography to assess collateral circulation before sacrifice of a distal artery. Two cases involved meningiomas with intimately associated arteries; one case involved a distal middle cerebral artery aneurysm that was not amenable to clip reconstruction, requiring trapping; and another case required complex clip reconstruction of a dysplastic middle cerebral artery aneurysm. Results: In all four cases, ICG videoangiography provided excellent real-time demonstration of sufficient collateral flow and retrograde filling after temporary occlusion of the artery in question. The relevant artery was sacrificed in each case, and all patients did well with no evidence of ischemia. Conclusions: Although this is a limited experience and cannot prove the safety of arterial sacrifice in all situations, our series demonstrates the potential usefulness of ICG videoangiography in assessing collateral arterial flow before sacrifice of distal cerebral arteries.",
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N2 - Objective: Generally, the sacrifice of arteries that perfuse normal brain parenchyma is avoided. However, there are instances when it is necessary to take certain distal arteries to adequately perform tumor resections or secure vascular lesions. Deciding whether the sacrifice of such arteries is safe can be difficult. Methods: We present four cases demonstrating the use of indocyanine green (ICG) videoangiography to assess collateral circulation before sacrifice of a distal artery. Two cases involved meningiomas with intimately associated arteries; one case involved a distal middle cerebral artery aneurysm that was not amenable to clip reconstruction, requiring trapping; and another case required complex clip reconstruction of a dysplastic middle cerebral artery aneurysm. Results: In all four cases, ICG videoangiography provided excellent real-time demonstration of sufficient collateral flow and retrograde filling after temporary occlusion of the artery in question. The relevant artery was sacrificed in each case, and all patients did well with no evidence of ischemia. Conclusions: Although this is a limited experience and cannot prove the safety of arterial sacrifice in all situations, our series demonstrates the potential usefulness of ICG videoangiography in assessing collateral arterial flow before sacrifice of distal cerebral arteries.

AB - Objective: Generally, the sacrifice of arteries that perfuse normal brain parenchyma is avoided. However, there are instances when it is necessary to take certain distal arteries to adequately perform tumor resections or secure vascular lesions. Deciding whether the sacrifice of such arteries is safe can be difficult. Methods: We present four cases demonstrating the use of indocyanine green (ICG) videoangiography to assess collateral circulation before sacrifice of a distal artery. Two cases involved meningiomas with intimately associated arteries; one case involved a distal middle cerebral artery aneurysm that was not amenable to clip reconstruction, requiring trapping; and another case required complex clip reconstruction of a dysplastic middle cerebral artery aneurysm. Results: In all four cases, ICG videoangiography provided excellent real-time demonstration of sufficient collateral flow and retrograde filling after temporary occlusion of the artery in question. The relevant artery was sacrificed in each case, and all patients did well with no evidence of ischemia. Conclusions: Although this is a limited experience and cannot prove the safety of arterial sacrifice in all situations, our series demonstrates the potential usefulness of ICG videoangiography in assessing collateral arterial flow before sacrifice of distal cerebral arteries.

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KW - Indocyanine green angiogram

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