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Assessment of ischemic risk following intracranial-to-intracranial and extracranial-to-intracranial bypass for complex aneurysms using intraoperative Indocyanine Green-based flow analysis
- Source :
- Journal of Clinical Neuroscience. 67:191-197
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Cerebral bypass is often needed for complex aneurysms requiring vessel sacrifice, yet intraoperative predictors of ischemic risk in bypass-dependent territories are limited. Indocyanine Green (ICG)-based flow analyses (ICG-BFAs; Flow 800, Carl Zeiss, Oberkochen, Germany) semi-quantitatively assess cortical perfusion, and in this work we determine the efficacy of ICG-BFA for assessing post-operative ischemic risk during cerebral bypass surgery for complex aneurysms. Retrospective clinical and pre/post-bypass intra-operative ICG-BFA data (delay and blood flow index [BFI]) on ten patients undergoing cerebral bypass for complex cerebral aneurysms requiring vessel sacrifice were collected from a single-institution prospective database and analyzed via non-parametric testing and logistic regression. Mean age was 55.9 ± 14.8 years. Pre/post-bypass delay (median 35.6 [5.1-51.3] vs. 26.0 [17.1-59.9]; p = 0.2) and BFI (median 56.1 [8.1-120.4] vs. 32.2 [3.0-147.4]; p = 0.2) did not significantly differ. Two patients (20%) developed post-operative ischemia in bypass dependent territories. Delay ratio did not differ between patients with and without post-operative ischemia (median 1.15 [0.67-1.64] vs. 0.83 [0.36-3.56]; p = 0.6), nor predict stroke risk (odds ratio = 1.1, p = 0.9). Conversely, BFI ratio was significantly lower for patients experiencing post-operative ischemia than those without ischemia (median 0.11 [0.06-0.17] vs. 0.99 [0.28-1.42]; p = 0.03). A BFI ratio0.21 predicted the occurrence of post-operative ischemia (odds ratio = 0.02, p = 0.05). These data suggest that intraoperative ICG-BFA may help assess post-operative ischemic risk during cerebral bypass surgery for complex aneurysms requiring vessel sacrifice.
- Subjects :
- Adult
Indocyanine Green
Male
medicine.medical_specialty
Ischemia
Stroke risk
03 medical and health sciences
chemistry.chemical_compound
Postoperative Complications
0302 clinical medicine
Extracranial intracranial bypass
Germany
Physiology (medical)
Internal medicine
Humans
Medicine
Prospective Studies
Aged
Retrospective Studies
Cerebral Revascularization
business.industry
Cortical perfusion
Intracranial Aneurysm
Mean age
General Medicine
Blood flow
Middle Aged
medicine.disease
Cerebral Angiography
Neurology
chemistry
Bypass surgery
030220 oncology & carcinogenesis
Cardiology
Female
Surgery
Neurology (clinical)
business
Indocyanine green
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 09675868
- Volume :
- 67
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical Neuroscience
- Accession number :
- edsair.doi.dedup.....07fb6fdd307829f55f95ff630cf96255