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

Abstract

BACKGROUND: Bypass patency is critical for patients undergoing superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. Near-infrared indocyanine green video-angiography (ICGA) is an excellent method to assess vessels during cerebrovascular surgery. OBJECTIVE: The aim of the present study is to analyze the effectiveness of ICGA in patients undergoing STA-MCA anastomosis for moyamoya disease. MATERIALS AND METHODS: This study was a retrospective review of case records and operation records of patients who underwent STA-MCA bypass for moyamoya disease at our institute. Concordance of ICGA with intraoperative micro-Doppler and postoperative angiography, whenever available, was assessed. RESULTS: In all, 22 STA-MCA anastomoses were performed in 13 patients. ICGA was used to assess patency in 14 surgeries (10 patients). No patient required revision of anastomosis following ICGA. Postoperative angiography was done in five anastomoses (three patients) at three months follow-up and correlated well with ICGA findings in all cases. CONCLUSION: 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.