Artikel
Indocyanine green videoangiography for stratification of recipient vessel selection in STA-MCA bypass surgery
Indocyaningrün Videoangiographie zur Bewertung und Selektion des Empfängergefässes bei STA-MCA Bypass Revaskularisierung
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Autoren
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Johannes Goldberg
- Charité – Universitätsmedizin Berlin, Berlin, Deutschland; Universitätsspital Bern, Bern, Switzerland
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Peter Vajkoczy
- Charité – Universitätsmedizin Berlin, Berlin, Deutschland
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Nils Hecht
- Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: The identification of the ideal recipient in STA-MCA bypass surgery remains debatable because there are no objective selection criteria if multiple options exist. We aim to assess the value of indocyanine green videoangiography (ICG-VA) for recipient vessel selection in STA-MCA bypass surgery.
Methods: Sixty patients that underwent 65 STA-MCA bypass procedures with pre- and post-anastomosis ICG-VA were included. The primary surgeon was blinded towards the pre-anastomosis ICG-VA. First, pre-anastomosis white-light and ICG-VA were compared regarding the identifiability of potential recipients and pathological flow patterns. Second, the effect of definite recipient selection on flow increase within the recipient was analyzed according to initial flow within the recipient, the sequence of appearance and the vessel diameter in ICA-VA. Third, recipient flow increase was analyzed according to pre-anastomosis recipient flow direction and bypass graft orientation.
Results: ICG-VA permitted identification of a significantly higher number of potential recipients (median 4, range 1-9) than white-light (median 2, range 1-5; *p<0.001) next to identification of pathological flow patterns in 20%. The recipient with the highest flow, earliest appearance and largest diameter was chosen in >45%. After bypass grafting, a significant recipient flow increase of 70±100% (*p=0.001) was noted. Interestingly, a higher flow increase occurred in recipients with initially low flow and late appearance (*p=0.01), whereas the recipient diameter had no influence on recipientflow increase (p=0.09). Further, a higher flow increase was noted in recipients with initially retrograde flow (p=0.02), whereas no difference was found depending on graft orientation (p=0.44).
Conclusion: ICG-VA facilitates identification of potential recipients and detection of pathological flow patterns in STA-MCA bypass surgery. Recipients with initially low flow, late appearance, and retrograde flow seem to bear the highest potential for flow increase, possibly due to a higher hemodynamic need for revascularization.
